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PubMed1980

Hemodynamic failure induced by narcotic and toxic doses of 12 CNS depressants in intact and pithed rats.

UNLABELLED: Heart rate (HR), cardiac output (CO), stroke volume (SV), arterial blood pressure (BP), and peripheral resistance (PR) were assessed in awake rats and in rats anesthetized with hexobarbital, pentobarbital, secobarbital, secbutabarbital, methaqualone, chloral hydrate, urethane, ethanol, guaiphenesine, meprobamate, diazepam and chlorpromazine (respired artificially). Anesthesia mostly was accompanied by an increase of HR and PR and a decrease of CO and SV, whereas BP remained unchanged or somewhat declined. Infusion of further amounts of the CNS depressants caused a dose-dependent decrease of HR, CO and BP but did not influence SV whereas PR declined but did not fall considerably beyond the values in awake rats. A strong decline of CO, SV and BP but no change of HR and PR occurred after pithing in rats. Anesthetic doses of hexobarbital, pentobarbital, secobarbital, secbutabarbital, methaqualone, and guaiphenesine produced no hemodynamic effects in pithed rats. Chloral hydrate, urethane, ethanol, meprobamate, diazepam, and chlorpromazine, on the other hand, in anesthetic doses depressed the CO and BP of pithed rats without influencing PR. In toxic doses, the CNS depressants caused comparable hemodynamic changes in pithed as in anesthetized rats. CONCLUSION: Hemodynamic failure induced by narcotic doses of CNS depressants is mainly due to a depression of the vasomotor center(s) and an impairment of cardiovascular reflex control, that after toxic doses is mainly caused by the direct cardiovascular-depressive actions of these drugs.

Animals↗
PubMed1980

Effects of succinylcholine on the electroencephalogram of dogs.

Electroencephalograms of 20 dogs given succinylcholine and concurrent artificial respiration were recorded. The amplitudes of the fast activity of the electroencephalograms were approximately one-fifth that observed in awake dogs. In addition, the occurrence of slow waves (6 to 8 Hz) was more marked in those dogs treated with succinylcholine. Succinylcholine caused a low amplitude dominant activity with increased moderate amplitude low frequency waves.

Animals↗
PubMed1995

[The Early Rehabilitation Barthel Index--an early rehabilitation-oriented extension of the Barthel Index].

The Barthel Index has been shown to be a good measure of reduced activities of daily living which can be applied in routine clinical practice in a valid and reliable manner. However, patients with severe brain damage cannot be differentiated appropriately as floor effects show up with increasing severity of neurological impairment, e.g. in comatose and near- or post-comatose patients in early rehabilitation. Aspects of functional deficits relevant in early rehabilitation patients have been introduced to the Barthel Index in a separate section, the Early Reha Barthel Index (ERI). These aspects are: state requiring temporary intensive medical monitoring, tracheostoma requiring special treatment (suctioning), intermittent artificial respiration, confusional state requiring special care, behavioural disturbances requiring special care, swallowing disorders requiring special care, and severe communication deficits. Experience with the ERI gathered with 210 early rehabilitation patients and 312 patients with severe brain damage demonstrate that the extended scale permits differentiation of patients according to severity and to avoid floor effects. Patients can be allocated appropriately to different phases of rehabilitation, i.e., early rehabilitation of patients with very severe brain damage or rehabilitation of patients with severe brain damage. The ERI is quick, economical, and reliable. Given the high cost of early rehabilitation it is expected to be of special interest also to health care providers to ensure that the right patient is looked after in the right bed.

Activities of Daily Living↗
PubMed1994

[First aid measures by lay persons in cardiovascular arrest].

The efficiency of first aid resuscitation is affirmed by many publications. In a questionnaire of the division of Cardiology of the Department of Internal Medicine, Graz and the Styrian Heart Patient Society distributed during the course of the Graz spring fair 1993 the population was approached as to first aid in cardiac arrest. 550 subjects responded to answer this circular for assessment dividing the population statistically in 4 different age groups showing differences among male and female and country and city dwellers. It has been shown that general first aid resuscitation has been known sufficiently, whereas special cardiorespiratory procedures (such as artificial respiration or cardiac massage) were unknown to most.

Adolescent↗
PubMed1995

[Pulmonary involvement in patients with myeloperoxidase specific-antineutrophil cytoplasmic antibody].

In order to examine the clinical features of pulmonary involvement in patients with myeloperoxidase specific-antineutrophil cytoplasmic antibody (MPO-ANCA), 46 MPO-ANCA positive patients with collagen-vascular disease and glomerulonephritis were investigated. Twenty eight patients (60.8%) had pulmonary involvement without tumor and infection, 20 (43.5%) of MPO-ANCA positive patients had interstitial pneumonitis, 11 (23.9%) had pulmonary hemorrhage, 3 had asthma (6.5%) and 7 had both interstitial pneumonitis and pulmonary hemorrhage. Patients with pulmonary involvement were older (mean age 61.1) and they had higher inflammatory acute phase reactants and higher mortality (42.9%) than patients without pulmonary involvement. Pulmonary hemorrhage revealed on both lung fields in 10 patients, 7 patients required artificial respirator and 6 died. Titer of MPO-ANCA increased paralleled with progression of pulmonary hemorrhage. Interstitial fibrosis revealed predominantly lower and lateral side of the lung. It is suggested that MPO-ANCA may be closely related to the pathogenesis of pulmonary hemorrhage and interstitial pneumonia. Careful management is needed in patients with pulmonary involvement, especially pulmonary hemorrhage in patients with MPO-ANCA.

Adult↗
PubMed1995

[Ventilatory insufficiency due to upper cervical injury treated by diaphragm pacing: a case report].

A 33-year-old man suffered chronic ventilatory insufficiency with tetraplegia after an operation for atlantoaxial dislocation. He was alert and his tetraplegia gradually improved. However, continuous mechanical ventilation was necessary for him. Thirteen months after the operation, a diaphragm pacer (Avery Laboratory Inc.) was implanted on the right phrenic nerve in the cervical region. Nineteen days after the implantation of the right side pacer, a left side diaphragm pacer was also implanted. Diaphragm pacing was started two weeks after the second implantation. The pacing period was gradually prolonged and continuous pacing for 9 hours by the right side pacer and three hours by the left side pacer was able to be obtained. One year after implantation, twelve continuous hours of diaphragm pacing became possible. During diaphragm pacing, blood gas analysis was satisfactory and the patient could move sitting on a wheel chair, watch television and write letters using a word processor. We were unable to achieve total ventilatory support for him using these diaphragm pacers. We thought that the main cause of our partial failure originated from the procedure used in implanting the electrode onto the phrenic nerve. Left side pacing needs higher amplitude than that used on the right side to obtain sufficient tidal volume. The patient refused our continuing the left side pacing because of pain around the anterior chest and shoulder. Another problem to be watched is diaphragm fatigue. However, diaphragm pacing has been continued for six years and it has been useful in improving his quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The effect of nimodipine on cochlear blood flow in the guinea pig].

The influence of nimodipine (Nimotop, CAS 66085-59-4), a selectively cerebrovascularly acting 1,4-dihydropyridine calcium antagonist, on the cochlear blood flow (CBF) was studied in 19 guinea pigs (6 controls). The hydrogen clearance measurements were carried out under alpha-chloralose-ethylurethane anaesthesia, artificial respiration with simultaneous control of electrocardiogram, blood pressure, body temperature and arterial pH (hourly). The indirect measurement of CBF was carried out by means of hydrogen clearance in the perilymphatic space (basal turn) before and after intravenous application of 1 microgram nimodipine/kg/min. The mean arterial blood pressure remained within the +/- 5% range of the initial value during the experiment. Under treatment with nimodipine the CBF showed a non-significant average increase of 4.69% and under placebo (20% ethanol, 17% polyethylenglycol 400, citrate buffer), a non-significant average decrease of 6.16%. The influence of nimodipine on CBF was underlined by the overcompensation of the placebo effect.

Animals↗
PubMed1994

[Experimental research on choroidal circulation. 2. Choroidal blood flow increase elicited by electrical stimulation of parasympathetic nerve behind the eyeball in the cat].

The present studies were performed to examine whether the nerves behind the eye ball contain parasympathetic fibers which dilate the choroidal blood vessels. Choroidal blood flow in the cat (20 animals) was measured trans-sclerally with a laser Doppler flowmeter. Cats were anesthetized with pentobarbital sodium (30 mg/kg, i.v.) and artificially respirated after injection of pancuronium bromide (0.2 mg/kg/hr, i.v.). Electrical stimulation of the short ciliary nerve as well as of the nerve between the ciliary ganglion and accessory ciliary ganglion, where the sensory nerve is absent, elicited an increase choroidal blood flow in an intensity-dependent manner. Application of capsaicin, which is known to desensitize the polymodal nociceptive C-fibers, to these nerves did not abolish the increase in blood flow in response to electrical stimulation of the short ciliary nerve. Atropine, a muscarinic receptor antagonist, and phentolamine, an alpha-adrenoceptor blocking agent, had no effect on these responses. The results suggest that the blood flow increase elicited by stimulation of these nerves is mediated via activation of the atropine-resistant parasympathetic vasodilator fibers supplying the choroid in the cat.

Animals↗
PubMed1994

[Intracranial pressure in sleep apnea, hydrocephalus and congenital hemangioma. A case report].

A patient with obstructive sleep-apnea-syndrome and congenital temporal and cervical hemangiomas developed severe headache under nasal BiPAP ventilation. Internal hydrocephalus was diagnosed by CCT and MRI and rise of intracranial pressure (ICP) under artificial ventilation was supposed. Polysomnography, ICP-measurement with a ventricular catheter and resistance to outflow-measurement were used to clarify differential diagnosis. During periods of apnea ICP was raised severely with a maximum in REM-sleep. With nasal ventilation no apnea was observed and ICP was normalized. Resistance to outflow was normal. A disturbance of CSF-dynamics or CSF-absorption leading to the patient's headache could be excluded. Duplex-sonography and cerebral angiography did not provide further information. After exclusion of other causes artificial respiration dependent swelling of the subcutaneous temporal and cervical hemangiomas was the most likely cause triggering the headache. A sufficient therapy however was not yet available. Probably the patient suffers from an abortive form of a Sturge-Weber-Krabbe-Dimitri-Syndrome.

Cerebrospinal Fluid Pressure↗
PubMedDate not supplied

Nonpharmacologic circulatory support in the brain-dead animal.

A nonpharmacologic technique for providing an artificial peripheral resistance enabled the canine heart to pump blood for 12 hours in a brain-dead (spinal) animal model. The artificial peripheral resistance was provided by binding the body with elastic bandage. The only other support provided was artificial respiration. Following the 12-hour preservation period, the hearts were challenged to pump by the intravenous infusion of saline. Aortic pressure, cardiac output (CO), oxygen uptake, body temperature, arterial Na+, K+, pH, and HCO3-, and transchest ECG were monitored in all five animals studied during the control and 12-hour preservation periods. Mean blood pressure fell to 50-60 mmHg following cervical cord transection, rising to above 100 mmHg when the body was bound with elastic bandage that restored the peripheral resistance. During the 12-hour preservation period the average mean blood pressure fell from 118 to 60 mmHg, at which point the average normalized CO was 34 mL/min/kg. Following the saline challenge, the average CO increased to 1.89 times the value at the end of the preservation period, representing an average normalized value of 64.3 mL/min/kg (a typical value for the normal resting dog is 70 mL/min/kg). Body temperature decreased slightly in four animals and increased slightly in one. Na+ was virtually unchanged throughout the control and preservation periods, but K+ increased slightly in all animals, exceeding 5 mEq/L in one animal after 8.5 hours and in another after 10 hours. HCO3- was almost constant in all animals, as was pH. However, the pH was elevated during the preservation period due to slight overventilation to assure a high oxygen saturation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1976

[Endangering hospital patients to infection by therapeutic measures (author's transl)].

About 5% of all patients fall ill with anosocomial infection, i.e. one acquired in hospital. Among the principal causes of this are therapeutic measures which lead to an increased exposure of patients to organisms (soiled artificial respiration equipment, venous catheters, urinary catheters etc.) and to a raised disposition in the patients due to reduction of endogenous defense (cytostatic therapy, corticoids irradiation, operations etc.). Cross infections are largely transmitted on the hands of doctors and nursing personnel. The detection, prevention and control of hospial infections by specially trained personnel (hospital infection officers, specialist hygiene nurses, hospital hygiene committees) is absolutely necessary and justified for economic reasons alone.

Adult↗
PubMed1994

[Sound frequency analysis for identification of venous air embolism].

Air emboli occurring during surgery are considered to be life-threatening incidents. With the aim of achieving acoustic identification of venous air emboli, a frequency analysis of the sounds induced by an air embolism (millwheel murmurs) as well as of all other unusual sounds, was undertaken during 20 operations, and in experiments with animals. The frequency spectra of the sounds induced by air emboli are characterised by an increase in the amplitudes in the frequency range 1,100 to 3,000 Hz, while the amplitudes of normal heart sounds continuously decrease with increasing frequency. The frequency spectrum was examined for characteristics using an electronic filter system. The sounds induced by air emboli can be clearly distinguished from normal heart sounds. During operations on patients, suction sounds occur, the frequency patterns of which are not easy to distinguish from those of embolus-induced sounds, although an acoustic distinction can be made via a stethoscope or a loudspeaker. With optimal adjustment of the filter system, 73 out of 81 (90%) embolism-related sounds were correctly identified in animal experiments. On no occasion were normal heart sounds wrongly identified as due to an embolus. However, an embolus sound was frequently mimicked by interfering sounds such as those produced by artificial respiration, and other ambiend sounds. By modifying the oesophageal catheter to achieve optimal suppression of interfering sounds, this filter system could be developed into an alarm.

Animals↗
PubMed1993

[Guillain-Barré syndrome in children treated with intravenous immunoglobulin].

The clinical course of subacute demyelinating polyneuropathy or Guillain-Barré syndrome (GBS) in adults is known to improve more rapidly and with fewer complications when treated with plasma exchange or intravenous immunoglobulin than supportive care alone. Recent results indicate the best improvement is found with intravenous immunoglobulin. In children little is known about the efficacy of intravenous immunoglobulin, though case reports seem to document effect. Three cases of GBS in children aged two, three and nine years, who all were treated with intravenous immunoglobulin 400 mg/kg/day for five days, are reported. There was marked clinical improvement during treatment in two children, the third child developed respiratory insufficiency needing artificial respiration during treatment, but improved rapidly after five days of intravenous immunoglobulin.

Child↗
PubMed1976

[Prognosis of purulent meningitis with particular reference to the beginning of treatment and age of the patient (author's transl)].

The relatively high lethality of meningitis is due to the delay in beginning treatment (usually caused by nonrecognition of the disease) and to the greater age of the patient (associated diseases). New aspects of the improvement of the prognosis were not obtained by comparison of various patient collectives a decade apart in our clinic, although an improvement in additional measures such as artificial respiration occurred. The reason lies in veiling by antibiotic premedication. Before beginning antibiotic therapy an exact etiological diagnosis should be made. This objective can only be attained by better training of the physician, including neurology.

Adolescent↗
PubMed1993

[Management of the patient with craniocerebral injuries at the accident site and clinic admission].

Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. The pattern of injuries was analysed; multiple injuries were found in 63 patients, with injuries to the extremities and the thorax being most-frequent. The primary preclinical treatment for patients with craniocerebral trauma is demonstrated; the indications for intubation and artificial respiration are discussed, and also the selection of drugs. Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.

Brain Injuries↗
PubMed1993

[A 93-year-old woman presenting consciousness disturbance, left hemiplegia, and respiratory distress].

We present a 93-year old female who abruptly developed left hemiplegia on the way to the wash room. She was admitted to another hospital where her consciousness deteriorated and artificial respiration was necessary. She was transferred to our hospital 20 days after the onset of her stroke. On admission, her BP was 60/40 mmHg, and wheezing râle was heard in both lung fields. No heart murmur was present. She was in comatose state, but a small amount of spontaneous movements were present in her eyelids and the jaw. Neurologic examination revealed no papilledema, small non-reactive pupils with the right side being slightly larger than the left, absence of ocular movements, and loss of oculocephalic response and corneal reflex. An intratracheal tube was in situ, and the observation of the pharynx was impossible. No stiff neck was present. No spontaneous movement was observed in her limbs which were flaccid, and all the deep reflexes were lost except for jaw jerk which was weakly positive. Cranial CT scans revealed low density areas in the right anterior and middle cerebral artery territories with patchy areas of high density being consistent with a hemorrhagic infarction. In addition, a small high density mass lesion was noted in the left frontal lobe adjacent to the falx, which was thought to be a small meningioma. Her clinical course was complicated by pneumonia, hypotension and cardiac failure. She expired 2 months after the onset of her stroke. Postmortem examination revealed an extensive hemorrhagic infarction involving the territory of the right internal carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[The physician and accidents. Legal and medical problems].

German law requires that any physician at a place of accident is obliged to help according to his training and ability. As an emergency doctor on duty he works in a warrantee position. In cases with multiple accident victims triage may be necessary, corresponding to the priority of medical care. In criminal procedures against a physician due to omitted help, there is no probative charge against the accused. On the other hand, civil law sets up an objective standard: attention as required in communication. In giving initial medical assistance for unconscious patients or injured children, rules of "authorized management without commission" become valid. Basic first aid measures involve: securing, saving and rescue. Life-threatening situations such as severe bleeding, airway obstruction and cardiac arrest must be dealt with immediately. Following this, such measures as proper positioning, clearing of the respiratory tract, removal of dental prostheses, evaluation of multiple injuries, avoidance of hypothermia and initiating infusions are mandatory. The orientating examination of the accident victim is described, as is the "ABCD Rule" for treating respiratory insufficiency or circulatory arrest and shock, using heart massage and artificial respiration. Finally, medical first aid is described for special injuries, such as cerebral or thoracic trauma, fractures and burns. The psychological situation affecting the physician at the place of an accident is characterized.

Accidents↗
PubMed1977

Pneumoperitoneum associated with pneumothorax: a surgical dilemma in the post-traumatic patient.

Two patients with pneumoperitoneum associated with post-traumatic pneumothorax are described. The role of artificial respiration in the production of pneumoperitoneum is descussed. This association presents a curious diagnostic dilemma. If the diagnosis of perforated hollow viscus can be eliminated with considerable certainty, then conservative management with careful observation and monitoring may avoid unnecessary surgery, so long as other causes of pneumoperitoneum have been ruled out.

Adult↗