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Biomedical subjects

A Henn-Beilharz

Publications and source records attributed to A Henn-Beilharz.

13 recordsLinked to original sources
PubMed2004

[The positioning of reinforced laryngeal masks (LMA) with the "Zerer-introducer"].

OBJECTIVE: Correct and rapid positioning of reinforced laryngeal masks (LMA) is often a problem in anaesthetics. Although different techniques have been developed, none of them are satisfactory. A newly designed introduction device was used to place reinforced laryngeal masks. These are first results of a clinical observational study. METHODS: A special fork fixed on a handhold was constructed. The introduction of the LMA was possible in an arched movement down to the hypopharynx using appropriate sizes for different sizes of LMA's. RESULTS: The intubation in 500 surgical cases (30 % adult, 70 % children, mostly in ENT-surgery) was easy and rapidly performed. A leading finger for placement was not necessary. There were neither cases of rotation nor retrograde flexion of the top of the mask. Direct vision by the ENT-specialist revealed no evidence of any injuries of the palate or throat. CONCLUSION: A newly designed introduction device allows a fast and efficient placement of reinforced laryngeal masks and contributes to the safety of this mode of application.

Adult↗
PubMed1996

[Mechanical autotransfusion also in transurethral resection of prostatic adenoma? Studies of preserved washed erythrocyte concentrates before possible retransfusion].

AIM: Does cell-saving during transurethral resection of prostatic adenoma (TURP) provide autologous washed erythrocyte concentrates (AWECs) of the same haematological and bacteriological quality as that of established indications of a cell-saving device? Should the cell-saving device be used routinely in TURP? METHODS: 37 patients underwent TURP with written, informed consent. All patients had antibiotic therapy prior to surgery. Shed blood was processed by a cell-saving device. AWECs specimens were analysed for red blood count, electrolytes, LDH, extracellular haemoglobin, osmotic fragility, blood culture and bacterial concentration. In addition, data of urine cultures, adenoma cultures and adenoma histology were analysed. AWEcs were not retransfused. RESULTS: Haematological quality was shown to be comparable to that of established applications of a cell-saving device. However, 82% of the AWECs were contaminated with bacteria. Concentrations were as high as > 10(6) bacteria/ml. Isolated bacteria ranged from e. coli and pseudomonas to staphylococci, streptococci and candidae. Bacteria found in the urine cultures of patients with urinary tract infections could also be isolated in their AWECs. 16% of the patients had prostatic cancer not know preoperatively. Mass of resected adenoma and volume of AWEC did not correlate. CONCLUSIONS: In despite of good haematological quality we considered the rate of 82% bacterial and 16% tumour cell contamination of the AWECs unacceptable and, contrary to some literature data, we no longer use a cell-saving device in TURP.

Aged↗
PubMed1995

[Patient-controlled analgesia (PCA) after urologic interventions].

Patient-controlled analgesia (PCA) is a well-accepted technique in postoperative pain management. We used PCA in three different protocols to find the optimum application form. Our study compared 100 patients with radical prostatectomy or transperitoneal tumor nephrectomy in three groups using piritramide. Group 1 (n = 16) received 1.2 mg/h continuously and a 3 mg bolus with a lock-out time of 90 min. Group 2 (n = 30) received 0.8 mg/h continuously and a 3 mg bolus with a lock-out time of 60 min. Group 3 (n = 54) received the same continuous infusion, but the lock-out time was only 30 min. After 24 hours we evaluated the quality of analgesia using VAS scale. The quantity of piritramide was equal in all groups (35.1 mg). An average of seven bolus applications were made during the observation period. In 27.6% of the patients (group 1: 30.4%; group 2: 35.0%; group 3: 23.1%) the bolus demand was refused by programme. The analgesia level was satisfactory in each group, with a VAS value of 27. There was no respiratory depression observed. In conclusion, on-demand analgesia proved to be a good and practicable method in postoperative pain management. Although the dosage of piritramide was not different in the three groups, we recommend the protocol of group 3 because of the lower refusal of bolus application. Therefore, this seems to be the best patient-adapted application form. Even though respiratory complications in the group 3 scheme are not expected, monitoring of respiration and vigilance are recommended.

Adult↗
PubMed1992

[The effect of blood conservation techniques on the plasma concentration and elimination of midazolam in patients undergoing hip joint surgery].

OBJECTIVE: The question was to evaluate whether haemodilution or intraoperative autotransfusion have an influence on plasma levels and clearance of midazolam. DESIGN: The study was designed as a prospective evaluation of patients with total hip joint replacement. The patients received neuroleptanalgesia supplemented with enflurane. After induction of anaesthesia with midazolam (0.1 mg/kg body weight) haemodilution procedure was started. During surgery a cell saver was used for blood salvage. In the recovery room drainage blood was also being processed by a cell saver. PATIENTS: The study includes 10 patients belonging to ASA-group II with an average weight of 79.4 kg (53-100 kg), at an average age of 57.9 years (44-68 years). MEASUREMENTS AND MAIN RESULTS: Midazolam was measured in patient blood and in autologous blood units by gas chromatography. 151 micrograms of midazolam, i.e. 1.8% of the initial dose was retransfused in hemodilution blood. By processing of blood in the cell saver, 99.5% of the amount of midazolam found in the sample unit was eliminated. The maximum quantity was 5.5 micrograms in the washed autologous red cell concentrate. CONCLUSION: Considering the analytic limit of 2 micrograms/l of midazolam in plasma, retransfusion of autologous blood cannot influence the plasma concentration of midazolam. Therefore, there is no risk of re-sedation in retransfusing autologous blood postoperatively.

Aged↗
PubMed1992

[The modified Magill forceps].

The Magill forceps are used for nasotracheal intubation, endotracheal suctioning, passing gastric tubes, placement of tampons in the nasopharynx and extraction of foreign material from the pharynx. There are several disadvantages of the standard Magill forceps; however: the danger of cuff perforation, the necessity of readjusting the forceps when placing a tube or catheter, and the risk of injury to the mucous membrane. For these reasons the standard Magill forceps have been modified: the jaws of the forceps have been changed to give curved atraumatic parts without any serrations or sharp edges. RESULTS. The resulting benefits are as follows: Reduced risk of injuring the mucous membrane and perforating the cuff. Tubes and catheter are safely guided between the semiround jaws, making it unnecessary to open the forceps repeatedly to advance the tube. Tampons being placed in the throat no longer get caught between the serrations, and even small foreign objects can easily be extracted from the pharynx.

Anesthesiology↗
PubMed1991

[Ways of economizing on homologous blood. Concepts of autologous blood transfusion].

Transfusion of homologous blood may be associated with various complications. In this review, the authors present concepts of prevention of homologous blood transfusion. Different autotransfusion techniques are discussed, i.e., predeposit of autologous blood, plasmapheresis, normovolaemic haemodilution, blood salvage with/without cell washing, postoperative blood salvage of drainage blood, anaesthesia and surgical techniques as well as drugs for minimizing blood loss. The third part of the essay deals with indications of each technique depending on the surgical field. The authors conclude with unanswered questions and problems of the future.

Blood Transfusion, Autologous↗
PubMed1990

[The origin of non-emulsified fat during autotransfusions in elective hip surgery].

In addition to hemodilution and preoperative blood donations, mechanical intraoperative autotransfusion (MAT) is an important method of preventing or minimizing the transfusion of homologous blood in operations with major blood loss. Using cell separators allows most of the problems of MAT to be solved, but the processed red cell concentrates of patients having hip joint replacement contain fat. Due to the high risk of fat embolism during bone surgery, as well as other circulatory problems, it is of interest whether the infusion of up to 15 ml of fat does not expose patients to an even higher risk. This study aimed to research the pathogenesis of fat embolism and possibly support one of the existing theories. METHODS. Semiquantitative oil measurement: in 45 cases with first insertion of hip joint prosthesis and 16 cases with change of prosthesis MAT was used intra- and postoperatively. For comparison, 10 patients with aortic aneurysm repair were checked for fat as well. In these cases MAT was only used intraoperatively. After the red cell concentrate was processed there was a time lag of 10 min to allow better sedimentation of fat. At the end of retransfusion 50 ml of blood were saved. They were then separated into 10-ml plastic tubes, centrifuged, and fat content was measured using a mm-scale. The results were transformed to ml by means of a previously determined calibration. Analogous to hematocrit values, it was thus possible to establish a lipocrit for these patients. In another 16 cases of hip surgery we carried out cholesterol/triglyceride investigations in red cell concentrates, and in 5 cases analysis of the fatty acids by gas chromatography was performed. RESULTS. The lack of an emulsifier causes biochemical analysis of cholesterol-triglyceride levels to be impossible. Therefore, triglycerides and cholesterol in MAT blood were below normal levels although a high quantity of fat could be seen in the blood. No oil was found in any of the patients in the vascular surgical group. There were 61 patients in the orthopedic group; no oil was found in 34.4%, we found 1-2 ml in 16.4%, and in 49.2% there was more than 2 ml of oil. With regard to age, sex, weight, height, and deviation from Broca index no significant difference in lipocrit could be seen. Differences in lipocrit were observed depending on the type of operation (i.e. new insertion/change of hip prosthesis), these were not significant possibly due to the small number of patients undergoing a change of prosthesis. The more MAT blood was transfused, the more significant were the rises in lipocrit level. The rinsing solution itself (1000 ml NaCl 0.9% with heparin 30,000 IU) does not influence the oil concentrations. Gas chromatography revealed that there was more than 40% oleic acid and 20% palmitic acid. Combined with linoleic acid, this comprised 4/5 of the total amount of oil (Table 3)...

Aged↗