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Biomedical subjects

A Heino

Publications and source records attributed to A Heino.

11 recordsLinked to original sources
PubMed1992

Results of 500 general surgery patients operated on in the ambulatory surgery unit.

This study examined the outcome of 597 general surgery operations performed on 500 patients in the ambulatory surgery unit of the University Hospital of Kuopio between November 1989 and May 1990. Endoscopies were excluded from the study. Spinal (41.0%) and local infiltration (31.2%) were the most often used forms of anaesthesia. During anaesthesia 15.8% of patients required treatment for hypotension, and 13.6% for bradycardia. Of the 351 (70.2%) patients, who returned the one month follow-up questionnaire, 41 (11.7%) had visited a doctor postoperatively. The main reasons for this visit were pain in 41 (100%), minor bleeding in 24 (58.5%) and inflammation in 16 (39.0%) patients. No deaths or other major complications were observed. 92% of the patients were satisfied with the treatment and anaesthesia.

Adolescent↗
PubMed1989

Correction of hemorrhagic shock-induced liver hypoxia with whole blood, Ringer's solution or with hetastarch.

Liver oxygenation was studied with hemorrhagic hypotension and corrected using whole blood, a synthetic colloid (hydroxyethyl starch or hetastarch, HES; mol. wt. 120,000), or a crystalloid solution. Measurements were performed directly by recording pig liver tissue oxygen tension with an implanted silicone elastomer (Silastic) tube, and indirectly by calculating blood oxygen contributions. The direct method seems fairly reliable and accurately reflects different levels of bleeding and shock and their correction. Liver tissue oxygen tension (PlO2) may thus be used as an indicator of central organ response to shock management. PlO2 decreased during bleeding from 33.5 +/- 0.5 to 16.0 +/- 0.5 torr, and normalized rapidly after retransfusion. The baseline values were significantly exceeded after hetastarch infusion but were never reached with Ringer's solution. The correction of liver oxygen consumption was less complete after crystalloid infusion as well. On the other hand, the difference in liver oxygenation was less marked after crystalloid infusion and retransfusion, which restored perfusion to the baseline. The total amount of Ringer's solution needed to keep the animals hemodynamically stable during the 2-h follow-up period was four times higher than with hetastarch and some five times the blood volume shed. The cause of defective correction of liver oxygenation seems to be the poor response of liver blood flow to refilling in the Ringer group, in addition to apparent tissue edema after crystalloid infusion. According to our study, hemorrhagic hypotension related to liver oxygenation is more promptly and completely corrected with the colloid hydroxyethyl starch than with a crystalloid solution in the early phase of treatment.

Animals↗
PubMed1988

Operative and postoperative non-surgical complications in diabetic patients undergoing renal transplantation.

Eighty-one insulin-dependent diabetic (19.7%) and 330 non-diabetic patients (80.3%) underwent renal transplantation between September 1977 and September 1981. Preoperatively, the diabetics had a higher incidence of ST-T-changes in ECG (62.2 vs. 39.8%) (p less than 0.001) as well as pulmonary congestion (14.5 vs. 5.2%) (p less than 0.05) and pleural effusion (10.1 vs. 4.5%) in chest X-rays than non-diabetic patients. The incidences of marked blood pressure changes and cardiac arrhythmias during anaesthesia did not differ between the groups, nor did the incidences of ischaemic heart attacks, pneumonia and pulmonary atelectasis in the chest X-rays during the first postoperative week. Diabetic patients had higher mortality during the first postoperative month (6/81; 7.4% vs. 4/330; 1.2%) (p less than 0.01) than non-diabetic patients.

Diabetes Mellitus, Type 1↗
PubMed1987

Comparison of atracurium and vecuronium in anaesthesia for renal transplantation.

In a controlled study, equipotent doses of atracurium (20 patients) or vecuronium (22 patients) were given randomly to patients with chronic renal failure anaesthetized for renal transplantation. There were no statistically significant differences in the degree of muscle relaxation (electromyographic twitch response) and circulatory parameters. Plasma histamine concentration increased in three patients after the first dose of atracurium, but in none of the patients could any signs of allergic reactions be observed. Tracheal intubation was difficult in six patients of the atracurium group, all of whom had diabetes mellitus and varying degrees of neck stiffness. The neuromuscular block response in diabetic uraemic patients was similar to that in other uraemic patients.

Anesthesia, General↗
PubMed1986

Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations.

This retrospective study consisted of 500 consecutive renal transplantations performed between September 1977 and September 1981. Preoperatively, congestive heart failure was registered in 262 cases (53.0%) and blood pressure disease in 352 cases (71.3%). The total number of patients with ischaemic heart disease was 22 (4.5%). General anaesthesia was given in 493 and regional anaesthesia in seven cases. In general anaesthesias, tubocurarine was the main relaxant and halothane the main inhalation agent used. Major complications during anaesthesia were blood pressure changes with a higher incidence of hypotension (49.6%) than hypertension (26.8%). Severe cardiac arrhythmias were rare and no intraoperative deaths occurred. One patient was successfully resuscitated in the ICU postoperatively, this being possibly related to hypoventilation caused by prolonged muscular relaxation. Other rare complications included one pneumothorax, one haemo- and hydrothorax, and two large haematomas all caused by preoperative central venous cannulation. In 69 cases (14.0%) additional neostigmine doses and in 34 cases (6.9%) naloxone was given at the end of anaesthesia. Pneumonia during the first postoperative week was recorded in 11 cases (2.2%), and occurred only in patients who received general anaesthesia. One of the three patients who died during the first week developed pneumonia postoperatively.

Adolescent↗
PubMed1985

Vecuronium in patients with and without renal failure.

Fifteen patients with and ten patients without renal failure (RF) were given vecuronium as the sole muscle relaxant during anaesthesia. RF patients were divided into two subgroups according to the daily diuresis (RF I, below 0.5 l/d; RF II, over 0.5 l/d). Vecuronium was given in small doses until the electromyographic twitch response showed 90% relaxation. The results showed great individual variations, and there were no statistically significant differences between the study groups in the parameters studied (ED90 dose, total consumption of the drug in mg kg-1 min-1, vecuronium plasma concentrations, twitch response) during induction and anaesthesia. After reversal of relaxation, the twitch response recovered more slowly in the RF I group than in the others (P less than 0.05). No complications occurred and it is confirmed that it is safe to use vecuronium as a muscle relaxant in patients with RF.

Adult↗
PubMed1984

Dose-response of tubocurarine in patients with and without renal failure.

Different initial doses of tubocurarine (0.1, 0.2, 0.3 and 0.4 mg kg-1) were given to 20 patients with and 20 patients without renal failure (RF) during standard anaesthesia. Neuromuscular blockade was registered with a device based on electromyography. A fluorescent technique was used to measure plasma tubocurarine concentrations, for which blood samples were drawn during induction and at reversal of neuromuscular block. The dose-response curves for the induction period were slightly steeper in patients with RF. A linear correlation between tubocurarine concentration and twitch response was found in both groups, although the curve had shifted to the left in RF patients. The total amount of tubocurarine used for surgical relaxation was lower in the RF than in the non-RF patients.

Acid-Base Equilibrium↗
PubMed1984

Comparison of intramuscular analgesia, intercostal block, epidural morphine and on-demand-i.v.-fentanyl in the control of pain after upper abdominal surgery.

Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54-0.99 micrograms min-1 + on-demand boluses of 7.2-13.5 micrograms (ODAC) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2-4.3 on a scale from 0-10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X-ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood-gas analyses there was a greater number of slightly elevated PCO2 values (6.0-7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814-2233 micrograms, as did the number of on-demand boluses, 3-155. At 24 h, an efficacy rating "good" was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as "good" or "fair".

Abdomen↗