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PubMedDate not supplied

[Anesthetic considerations in patients with human immunodeficiency virus infection].

In the last few years many articles have been published on AIDS, the mechanism of transmission, prophylaxis and therapeutic possibilities; however, very few publications are available related with anesthesia of patients infected with HIV or AIDS. The authors have therefore undertaken this review in which following a brief description of the etiology, pathogenesis, physiopathology and treatment of the disease, the problems of anesthesia are specifically dealt with. The need for knowing the different active or latent clinical alterations, such as neurologic (encephalitis, meningitis, peripheral neuropathies, myelopathies, etc.), respiratory (pneumonias by Pneumocystis carinii), cardiovascular (myocardiopathies), digestives (oropharingeal candidiasis, hepatopathies), psychologic (drug addiction), hematic (anemias, leucopenias) coagulopathies, nephropathies, etc. must be emphasized. Before the possibility of such a broad pathology good evaluation and preoperatory preparation is essential. With regard to anaesthetic technique, regional anesthesia is of choice except in certain cases of neuropathies. Although patients with a high degree of immunosuppression present a high risk of infections of the nervous system, the global risk is lower than if general anesthesia with prolonged artificial respiration were received.

Anesthesia, Conduction↗
PubMed1996

[Ion-selective microelectrodes: principle and application of in vivo measurements of ionic concentrations in cochlear endolymph].

OBJECTIVE: To introduce the method of making neutral carrier ion-selective microelectrode and use it for in vivo measurement of ionic concentrations in cochloear endolymph. METHODS: GG-17 glass capillaries with 1.85 mm O.D. were rinsed extensively and dried in an oven. Two capillaries were parallelly connected and pulled with microelectrode puller to make a double-barreled micropipette. One barrel was back-filled with ion exchanger and internal reference solution, which served as ionic potential electrode, while the other barrel filled with 150 mmol/L KCL as reference electrode. Each barrel of microelectrode was connected to differential electrometer via Ag-AgCl wire and output was recorded on a three-channel recorder. Every ion-selective microelectrode was calibrated in a series of standard solutions to determine the required characteristics. Twenty healthy guinea pigs with normal hearing were anesthetized and were artificially respired through the tracheal canal after the intramuscular injection of suxamethonium chloride. The tympanic bulla was exposed and a double-barreled ion-selective electrode was inserted into the scala media through the round window and basilar membrane. The ionic potentials and endocochlear potentials (EP) were simultaneously recorded from the basal turn of the cochlea. Ionic concentrations were then calculated by Nicolsky-Eisenman equation. RESULTS: The concentrations of potassium, sodium and calcium ions in the cochlear endolymph were 146.3 +/- 11.8 mmol/L, 0.36 +/- 0.22 mmol/L and 16.2 +/- 5.7 micromol/L, respectively. CONCLUSIONS: The neutral carrier ion-selective microelectrode made with the above method is reliable and therefore can be used for accurately measuring the ionic concentrations of microenvironment in vivo continuously and transiently.

Animals↗
PubMed1977

[Electrophysiology of the telencephalic cortex in reptiles (lacerta galloti); EEG and evoked potentials (author's transl)].

EEG recordings were made on the telencephalic cortex of the saurius Lacerta galloti by means of chronically and acute implanted electrodes. In acute experiment cases, the animal was curariced and given artificial respiration. In chronic experiment cases the recordings were made extradurally, epicortically and subcortically. Evoked potentials were obtained by optical, acoustic and somatosensory stimulations. The results show two main aspects: 1. High amplitude slow waves. 2. Very abundant spindles of high frequency. They also show clear responses to sensorial stimuli but without precise topographical localization.

Acoustic Stimulation↗
PubMed1996

[Acute pulmonary edema caused by hydrochlorothiazide].

A 50-year-old woman who received a prescription for hydrochlorothiazide for 'swollen ankles', developed respiratory distress due to acute pulmonary oedema within a few hours after she took the first dose. She was treated with artificial respiration during 3 days and with dopamine and circulatory volume suppletion. She recovered completely. Patient had stopped earlier use of hydrochlorothiazide because of respiratory discomfort. The described adverse effect is rare, but because of the high use of this drug it is important to recognize it.

Diuretics↗
PubMed1977

[Prevention of complications after lung resection (author's transl)].

Experiences with prophylaxis of postoperative complications in 1179 lung resections (1960 to 1974) are discussed. Preoperatively exercises in breathing, inhalations with mucolytic and proteolytic drugs, in some cases therapeutic bronchosopy are used. An atraumatic thoracotomy with minimal cutting of muscles is preferred. In the postoperative course early mobilization of the patients and substitution of large amounts of fluid are used. The number of postoperative complications was reduced from 15,2% (1960 to 1966) to 2,6% (1971 to 1974). Artificial respiration or postoperative therapeutic bronchoscopy were not necessary during the last 6 years.

Breathing Exercises↗
PubMed1995

Inhibition by nitroglycerin of canine platelet aggregation and cyclic flow reductions in stenosed coronary arteries.

The aim of this study was to investigate the hypothesis that the action of nitroglycerin on acute coronary arterial diseases is due to the inhibition of platelet aggregation. Anesthetized open chest beagle dogs under artificial respiration were used. Cyclic flow reductions were induced by partial occlusion of the left anterior descending coronary artery at the site of endothelial injury. Nitroglycerin (20 mu g/kg followed by 3 mu g/kg/min, i.v.) attenuated the frequency and severity of cyclic flow reductions but did not recover the reduced coronary blood flow to baseline. Nitroglycerin completely abolished cyclic flow reductions in 3 of 7 animals. In other animals, intravenous injection of the same dose of nitroglycerin inhibited ex vivo platelet aggregation evoked by adenosine diphosphate (ADP, 10 mu M). However, nitroglycerin failed to suppress the platelet aggregation induced by a combination of ADP (1 mu M) with 5-hydroxytryptamine (5-HT, 1 mu M). In other experiments, diltiazem (calcium antagonist; 0.1 mg/kg, i.v.) did not affect cyclic flow reductions, and DP-1904 (inhibitor of thromboxane A2 synthetase; 1 mg/kg, i.v.) completely abolished cyclic flow reductions in 6 of 7 animals. These results indicate that nitroglycerin can inhibit cyclic flow reductions in part by attenuating the action of ADP on platelet aggregation, and that nitroglycerin is less potent than thromboxane A2 synthetase inhibitor in this model.

Animals↗
PubMed1977

[Adrenergic regulation and adrenoreactivity of the rat heart during adaptation to altitude hypoxia].

Male albino rats were adapted to 6 km "altitude" in barocamber. Responses of their hearts in open chest and on artificial respiration to noradrenaline and propranolol were studied. Values of the heart contractory function were by 32-140% higher in experimental animals than in control those. This excess could be eliminated by propranolol which shows it to be due to exaggerated effect of the adrenergic regulatory link. Adrenaline raises the heart function almost up to the maximal limit in adapted animals. This is followed by an increased rate of disappearance of the noradrenaline inotropic effect.

Adaptation, Physiological↗
PubMed1997

[Cardiopulmonary resuscitation already in Egypt 5,000 years ago?].

In light of the medically relevant features of the ancient Egyptian mouth-opening ceremony, the question of the effectiveness of medical practices in Egypt thousands of years ago is examined, whereby the religious and cultural framework also plays a significant role. In the Land on the Nile myth and reality clearly generated special conditions which favoured the systematic treatment of questions of resuscitation. Numerous examples show that this had practical consequences in the area of everyday medicine. In addition, rebirth and resurrection were central elements of the cult of the dead which had exact medical equivalents. These equivalents may demonstrate the advanced state of resuscitation practices in Egypt at that time. In this context, a reconstruction of an ancient Egyptian mouth-opening instrument is presented. In the cult of the dead, this instrument played a role which can be compared to the function of a modern laryngoscope. It appears possible that at the time of the pyramids the Egyptians already had an understanding of the technology required to perform instrument-aided artificial respiration. Whether or not they actually possessed a fundamental knowledge of the principles of cardio-pulmonary resuscitation remains unclear. Nevertheless, the astonishingly functional characteristics of the reconstructed mouth-opening instrument suggest that it was developed for more than purely symbolic purposes.

Burial↗
PubMed1977

[Metabolic effects of acute experimental hypoxia and hypercapnia].

Hypoxia and the hypercapnia were produced in anesthetized dogs by artificial respiration with appropriate gas mixtures, and a study was conducted of the effects of these conditions on various metabolic parameters, viz. catecholamines, renin activity, lactate, pyruvate, cortisol, non-esterified free fatty acids (FFA), and ammonia, in the plasma of the arterial blood. Hypercapnia caused a distinct increase in catecholamine concentrations, renin activity and ammonia, and a decrease in lactate and pyruvate; cortisol and FFA levels were only slightly altered. Hypoxia increased lactate, pyruvate and--though only to a slight extent--FFA, cortisol and NH3. The changes induced by hypercapnia were chiefly attributable to activation of the sympathico-adrenal system; those induced by hypoxia were not.

Ammonia↗
PubMed1997

[Adequate preservation of organs in brain-dead patients with a view to transplantation].

There exists a shortage of donor organs. Inadequate medical treatment of brain-dead patients results in one-third of the available organs not being suitable for transplantation. Adequate preservation of organs in brain-dead patients increases the supply and quality of donor organs. This preservation comprises the following measures: management of hypotension with a view to adequate perfusion of the organs (administration of fluid, if necessary erythrocytes, and of sympathicomimetic agents); adjustment of artificial respiration to the reduced carbon dioxide production in the tissues (lowering the respiratory minute volume) and to desired oxygenation (positive end-expiratory pressure, increase of the proportion of oxygen in the inhaled air, lengthening of the inspiration time); preventing excessive cooling of the body of the brain-dead patient due to failure of the temperature regulation (heating blanket, heating mattress, warming infusion fluids and inhaled air); treatment of diabetes insipidus in hypophyseal insufficiency (intravenous desmopressin); prevention and treatment on infections (antibiotics, bronchial toilet, variation of position).

Body Temperature Regulation↗
PubMed1997

Prevention of secondary hemorrhage in Hanuman syndrome (open mediastinal drainage).

The author describes three common mechanisms of hemorrhage which may occur following "open management" of sterno-mediastinitis after cardiac surgery. Recommendations for prevention and treatment are presented including the suggestion that whenever sterno-mediastinitis is treated by the open method in the initial stage of management, the patient should be paralyzed and maintained on artificial respiration.

Cardiac Surgical Procedures↗
PubMed1998

Organization and activity of the health service in the Croatian province of Lika in the first year of the war.

The aim of this report is to present the various aspects of the reorganization of the health service in the Croatian province of Lika during the first year, 1991-1992, of the war in Croatia. In the former Socialist Republic of Yugoslavia, the health service was completely in the hands of the state, and Croatia was not able to transform it in the first year of its independence. The paper documents the personnel, supplies, and equipment that the health service of Lika had at its disposal in the first year of the war, the division of the health service into the stationary and front-line medical corps, and the evacuation protocols developed to transfer surgical patients to the rear-area hospital. The response of the health service allowed for rapid and successful patient treatment, emphasized by the fact that the usual time elapsed between wounding and delivery of the patient to the operating table was less than 30 minutes. All surgeries, with the exception of those involving severe craniocerebral injuries, were performed in the war hospitals of Lika. After stabilization of their postoperative condition, generally within 30 minutes, patients were evacuated to the rear-area hospital in Rijeka, with artificial respiration. The distance by road from the war hospitals in Otocac and Gospić to the reararea hospital in Rijeka was 120 and 170 km, respectively. Collectively, the results of our work demonstrate that a nonmilitary health service can be transformed successfully and efficiently into a war medical service. Yet, we believe that this is possible only under the extreme conditions of a defensive war.

Croatia↗
PubMed1997

[Gastrectomy with radical D2 lymph node excision--effective and economically standardized therapy of adenocarcinoma of the stomach].

In a retrospective single center study, the impact of radical D2-lymph adenectomy and splenectomy on operativ course, morbidity, mortality and long-term survival, in 243 patients who underwent radical surgical therapy for gastric cancer, was analyzed. D2-lymph node dissection during gastrectomy or gastric resection did not influence blood loss, artificial respiration time, ICU days or surgical morbidity, whereas splenectomy correlated with a higher hospital mortality, leakage and abscess rate. Due to routinely performed D2-lymphadenectomy long term survival rate (5 years) was 40.6% for all (in detail: 96% in stage IA; 68.5%/IB; 61.2%/II; 35.8%/IIIA; 17.3%IIIB; and 2.6% in stage IV and 58.1% for curative resected patients.

Adenocarcinoma↗
PubMedDate not supplied

[The desire for information and informed consent in general anesthesia].

BACKGROUND: In the last years the interest for Informed Consent (IC) in anaesthesia has been growing and it has been debated on the adequate explanations in order to obtain a consent. The purpose of the present study was to assess patients' desire for information about anaesthesia. METHODS: In this prospective study a form has been given to consecutive patients waiting for surgical operation in general surgery or ear nose throat surgery and able to read and write, to inform them about the necessity of General Anaesthesia (GA); they were asked to complete a questionnaire concerning their desire for information about the following six items concerning anaesthesia: "the duration of anaesthesia"; "what type of pain will I have when I come round, and what pain-killers will I be given"; "details on the various types of anaesthesia, how and where will I be anaesthetized"; "what are the most common complications of general anaesthesia"; "where and how will I come round from general anaesthesia"; "what is artificial respiration in general anaesthesia". RESULTS: 107 patients participated in the study, 24 of whom were undergoing surgery for malignant cancer and 83 for benign non-oncological diseases. More than two-thirds of patients expressed their wish to receive information, and the trend of desire to know was inversely related to age (p < 0.05). There was no significant statistical difference in the desire to know according either to sex or to the kind of disease (benign or malignant). The demand for information about pain was particularly high (85%), also in the older group of patients. The results and the difficulties for obtaining IC are debated. CONCLUSIONS: The growth of patients' desire for information about anaesthesia is an aspect of the evolving doctor-patient relationship in Italy. Efforts should be directed at improving reciprocal communication.

Anesthesia↗
PubMed1998

[Evaluation of risks for postoperative pulmonary complications using a preoperative consultation system].

We retrospectively investigated the perioperative management and postoperative pulmonary complications of patients who had preoperative respiratory problems and consultations with anesthesiologists. These patients numbered eight hundred, 23.7% of all patients who had preoperative consultations, and 40.9% and 62.0% of the 800 had preoperative and postoperative respiratory management, respectively. Forty eight patients (6.0%) received postoperative artificial respiration. One hundred and twenty four patients (15.5%) had some respiratory complications post-operatively, and 5 patients (0.7%) died mainly because of the complications. In an evaluation of these patients with the modified predicted risk factors of Okutsu including the obesity factor and smoking history, there was no respiratory complication in patients under 14 points. Patients with high points of more than 20 included almost all of the patients (114 patients, 91.9%) who had postoperative respiratory complications. We conclude that our preoperative consultation system works well and that the modified predicted-risk factors for postoperative pulmonary complications is useful for the standardization and objectivity of preoperative patient evaluation.

Humans↗
PubMed1998

Cardiopulmonary effects of bilateral hemithorax ventilation and diagnostic thoracoscopy in dogs.

OBJECTIVE: To describe alterations in respiratory and cardiovascular variables during diagnostic thoracoscopy, using bilateral hemithorax ventilation with sustained pneumothorax. ANIMALS: 7 adult dogs. PROCEDURE: Each dog was anesthetized and instrumented for 2 episodes of cardiopulmonary monitoring that were performed at an interval of more than 14 days. The first anesthetic episode served as a control procedure for the thoracoscopy treatment performed during the second anesthetic episode. Multiple cardiopulmonary variables were evaluated by comparing changes from baseline values within treatments and between treatments. RESULTS: Arterial oxygen tension decreased significantly from baseline values during thoracoscopy but was unchanged during sham treatment. Arterial carbon dioxide tension, clinical shunt fraction, and systemic mean arterial pressure increased during thoracoscopy. In contrast, these variables were unaffected by the sham treatment. Heart rate and cardiac index increased during sham and thoracoscopy treatments; however, the increase was significantly greater during thoracoscopy. Total peripheral vascular resistance significantly decreased from baseline values for both treatments, but the decrease was greater during thoracoscopy. Significant changes were not observed for oxyhemoglobin saturation or pulmonary vascular resistance during either treatment. Dogs recovered without major clinical complications. CONCLUSIONS: Significant changes were found for several cardiopulmonary variables during bilateral hemithorax ventilation with sustained pneumothorax for diagnostic thoracoscopy of clinically normal dogs. CLINICAL RELEVANCE: Diagnostic thoracoscopy with bilateral hemithorax ventilation and sustained pneumothorax is well tolerated in clinically normal dogs and may provide a diagnostic modality enabling intrathoracic procedures with less morbidity than thoracotomy for dogs with intrathoracic disease.

Animals↗
PubMed1998

[Special aspects of anesthesia in patients with epidermolysis bullosa based on a case example].

Epidermolysis bullosa hereditaria dystrophica (Hallopeau-Siemens) is a rare autosomal recessive disease characterized by extreme bullae formation of skin and mucosa. Typical dystrophic nails and flexion contractures of the joints can lead to deformities. Carious teeth and microstomia caused by scarred contractures of the lips are characteristic of the clinical picture. Depending on the form and severity of epidermolysis bullosa, the anaesthetic and surgical management requires careful planning to avoid unnecessary complications as a result of positioning, anaesthesia or surgery. In cooperation with the patient, optimal positioning on the operating table without pressure or tangential friction of the skin needs to be achieved. Wherever possible, surgical tape and adhesive electrodes should be avoided. Artificial respiration, intubation and monitoring must be adapted to the skin conditions of the patient. In particular the skin below the blood pressure cuff must be protected by adequate padding, and maximum intervals between measurements should be chosen. Nasal, oral, laryngeal and tracheal manipulations should be kept to a minimum for protection of the upper airway. Fibre optic intubation is to be preferred because of the possibility of microstomia and the need for simultaneous airway diagnosis. In addition, oro- or nasopharyngeal tubes and catheters should be avoided where possible. Depending on the course of surgery and anaesthesia, postoperative therapy in an intensive care unit should be considered.

Adult↗