Biomedical subjects
A Rothhammer
Publications and source records attributed to A Rothhammer.
[Frequency distribution of dibucaine numbers in 24,830 patients].
PURPOSE: Atypical cholinesterase prolongs the duration of neuromuscular blocking drugs such as succinylcholine and mivacurium. Measuring the dibucaine number identifies patients who are at risk. This study shows the frequency distribution of dibucaine numbers routinely measured and discusses avoidable clinical problems and economic implications. METHODS: Dibucaine numbers were measured on a Hitachi 917-analyzer and all dibucaine numbers recorded over a period of 4 years were taken into consideration. Repeat observations were excluded. RESULTS: A total of 24,830 dibucaine numbers were analysed and numbers below 30 were found in 0.07% ( n=18) giving an incidence of 1:1,400. Dibucaine numbers from 30 to 70 were found in 1.23% ( n=306). On the basis of identification of the Dibucaine numbers we could avoid the administration of succinylcholine or mivacurium resulting in a cost reduction of 12,280 Euro offset against the total laboratory costs amounting to 10,470 Euro. CONCLUSIONS: An incidence of 1:1,400 of dibucaine numbers below 30 is higher than documented in the literature. Therefore, routine measurement of dibucaine number is a cost-effective method of identifying patients at increased risk of prolonged neuromuscular blockade due to atypical cholinesterase.
[Nitrous oxide today - a literature based clinical evidence].
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[Rocuronium or vecuronium for intubation for short operations in the preschool age? Effects on time in the operating room and postoperative phase].
This prospective randomized study compares the effects of rocuronium (R) and vecuronium (V) on the early postoperative period in infants. Forty-eight infants between the ages of three and six, scheduled for elective ENT procedures, were studied after prior approval of local ethics committee and informed parental consent. All children were premedicated with chlorprotixene and belladonna. Anaesthesia was induced with 5 mg/kg thiopentone and 1 vol.-% halothane. Subsequently, 0.4 mg/kg rocuronium or 0.075 mg/kg vecuronium were administered, respectively. Anaesthesia and post-operative care were conducted by independent anaesthetists, who were unaware of the drug used and of the relaxometric data obtained. All children were monitored in the recovery room by pulse oximetry until they reached a Steward Score of 6. Demographic data did not differ between the groups. No differences were recorded between the non-depolarizing relaxants regarding intubation time (R: 24.1 +/- 4.2 min, V: 25.8 +/- 6.8 min) and the time interval from end extubation to leaving the operating theatre (R: 2.3 +/- 0.8 min, V: 2.6 +/- 1.2 min), respectively. Similarly, no differences in SaO2 were noted during the recovery period in the recovery room. Significant differences between the non-depolarizing relaxants were found in the TOF-ratios at extubation (R: 0.73 +/- 0.31 min, V: 0.48 +/- 0.34 min) and arrival in the recovery room (R: 0.88 +/- 0.21 min, V: 0.69 +/- 0.26 min). 0.4 mg/kg Rocuronium and 0.075 mg/kg vecuronium can be used for intubation during short operations on pre-school children. Rocuronium may be the better alternative, due to its faster neuromuscular recovery properties.
P-V approach revisited.
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[Tissue oxygenation: physiological and pathophysiologic aspects in intensive care].
Continuous oxygen supply to the tissues is one of the many important factors in intensive care. However, as a basic requirement for the structure and function of higher developed organisms energy production by oxydative metabolism is of outstanding importance, because there is no significant storage of energy and anaerobic metabolism is insufficient. The determinants of oxygen supply--blood flow and oxygen content--are well known. The system stands out for its extensive ability to compensate imbalances. Nevertheless one has to bear in mind also rather trivial disturbances like insufficient respiration and hypovolemia. Absolute values of global parameters, however, provide no information on the oxygen supply of individual organs that are variably susceptible to hypoxia. Regional perfusion and tissue respiration are influenced by various factors. Together with systemic components the physiologic oxygen transport along the oxygen cascade follows demand. Regardless of their position on the oxygen cascade malfunctions of oxygenation impair first the function and eventually the structure of the tissues. An utilisation block on the cellular level can prevent sufficient energy production despite optimized oxygen supply, the damage of reperfusion can intensify the effects of hypoxia. Typical haemodynamic patterns follow the tissue hypoxia. For maintaining an equilibrium between oxygen demand and supply it is important that oxygen consumption is also influenced by numerous factors. Only when an imbalance between oxygen supply and demand--an oxygen debt--is realized at an early stage, the critically ill patient can be saved from irreversible damage. In the field of intensive care the frequently latent tissue hypoxia is often a result of the chronic oxygen debt of individual, particularly vulnerable organs. Considering those aspects the intestinal mucosa is particularly suited for the monitoring of tissue oxygenation in the critically ill patient.
[Gastric mucosa tonometry in routine monitoring in the surgical intensive care unit].
PURPOSE: Monitoring tissue oxygenation in the splanchnic region could be helpful for critically ill patients. In this study the postoperative course of gastric mucosal CO2 (prCO2) in 40 patients is shown. METHODS: Following approval of the ethics committee, 24 patients schedulded for surgery with an expected large fluid turnover and 16 multiple injured patients were monitored with a gas tonometry device in addition to standard monitoring (ECG, pulse oximetry, capnometry, CVP, arterial pressure). Normoventilated patients with prCO2 > 50 for more than 30 minutes were treated with fluid therapy, followed by catecholamine therapy, followed by transfusion (fig. 1). All patients were admitted to the SICU post-operatively. RESULTS AND DISCUSSION: The variation of prCO2-values was greater in multiple injured patients. Their prCO2-values began in a lower range compared to patients with scheduled operation, became higher at the end of the first SICU-day and remained higher thereafter. They had a higher fluid turnover and needed more catecholamines. Multiple injured patients with an arterio-intestinal CO2-Difference (CO2-Gap) > 10 had a higher ISS-Score, were longer mechanically ventilated, had a longer SICU-stay and a higher incidence of complications in comparison to patients with aCO2-Gap < 10. Perhaps a CO2-Gap > 10 could be predictive for a more severe course in intensive care patients.
[The interaction of nitrous oxide and enflurane on the EEG median of 2-3 additive, but weaker than at 1.0 MAC. Remarks on the work of H. Ropcke and H. Schwilden. Anaesthesist (1996) 45.819-825].
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[Clinical experiences with alfentanil for balanced anesthesia in upper abdominal surgery].
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[Nitrous oxide in combination anesthesia. Quantitative aspects of the effect of nitrous oxide].
UNLABELLED: Minimal Alveolar Concentration (MAC) defines the anesthetic potency of nitrous oxide (N2O) combined with an inhalational anesthetic only for the moment of skin incision. For the complete operation, the proportional action of N2O is unknown. This prospective, randomized study reports the mean intraoperative concentration (MIC) of halothane with and without 70% N2O in combination with premedication, i.v. induction, and muscle relaxation for the duration of operation. METHODS: Forty ASA I-II patients scheduled for hysterectomies gave informed consent. All patients received atropine 0.5 mg, promethazine and pethidine 1 mg/kg i.m. 30-45 min prior to anesthesia, i.v. induction with thiopental, and neuromuscular blockade with alcuronium at the beginning of the operation. Post-induction, patients received randomized halothane in 30% O2/70% N2 (group 1, n = 20) or in 30% O2/70% N2O (group 2, n = 20). In the course of this observation (before induction and up to 15 min after extubation), the following parameters were measured (Table 1): arterial pressure (AP), heart rate (HR), plasma concentrations of growth hormone, prolactin, and cortisol in central venous blood, esophageal temperature, "train-of-four" ratio, and expiratory CO2 concentration. MIC had been computed from the integral of end-expiratory halothane concentration during the course of the operation. RESULTS: Biometric data and concomitant conditions were equivalent within the two groups (Table 2). MIC halothane was 0.72 +/- 0.014 vol% in group 1 (O2/N2) and 0.52 +/- 0.01 vol% in group 2 (O2/N2O).(ABSTRACT TRUNCATED AT 250 WORDS)
[Hemodynamic side effects of high-frequency jet ventilation as a function of lung volume. Impedance spirometric studies].
In five patients with acute respiratory insufficiency the changes in tracheal pressure (P), lung volume (V) and transthoracic electric impedance TEI (Z) were measured during delayed expiration all over the inspiratory capacity (IC) from TLC to FRC. The quasi-static V/Z- and Z/P-curves were two-dimensionally displayed, and the Z/P-curve was volume-calibrated on the Y-axis (Z) using the linear V/Z-relationship. During high-frequency jet ventilation (HFJV, 200/min), the Z- and P-excursions were displayed on the "frozen" Z/P-curve as flat discs. By well-aimed increase in driving pressure and I/E-ratio the unknown FRC was enhanced in 4 stages (I-IV) by 0.33 IC, 0.5 IC, 0.66 IC and 0.75 IC, to measure haemodynamic reactions 10 minutes later (Swan-Ganz catheter). The pulmonary vascular resistance remained unchanged between stage I and II. It changed moderately in stage III (+14%) and was found to be markedly increased in stage IV (+45%). The increase in PVR was well parabolically correlated (r = 0.88) to the fraction of IC by which FRC was expanded. In a previous study a very similar function could be documented by us for the end-inspiratory lung volume during conventional PEEP ventilation. Concomitant to the increase in PVR the CI fell linearilly (r = 0.95). We conclude from our results: 1. TEI may be of value in monitoring HFJV. It offers the possibility to measure the increase in lung volume ("PEEP effect") and to titrate it deliberately within the usable volume range IC. 2.(ABSTRACT TRUNCATED AT 250 WORDS)
[Myoelectric activity of the colostomy with sphincter muscle replacement].
A continent colostomy was performed on 15 mongrel dogs by free transplantation of autologous smooth muscle. The myoelectrical observations of this colostomy and of a 3 years old human transplant show a vital and high active sphincter mechanism.
[Life-threatening anaphylactoid reaction following etomidate].
In a patient scheduled for coronary artery bypass grafting induction of anaesthesia resulted in a life-threatening anaphylactoid reaction with development of an erythema of the neck. Severity and duration of hypotension and tachycardia were such as to require intensive management and postponement of surgery. Skin tests ruled out any other cause except etomidate. Hence for definite surgery exactly the same induction manoeuvre was chosen, but etomidate was omitted. Anaesthesia and surgery proceeded completely uneventfully. There can be no doubt that this anaphylactoid reaction (grade III according to the classification proposed by Lorenz and Doenicke) was caused by etomidate.
[Control of the position of central venous catheters by intracardial ECG. A presentation of the method and its advantages compared to roentgen control].
It is obligatory to control the localization of a central venous catheter. We describe a simple own method for controlling the correct position of a central venous catheter electrocardiographically. The reported method is accurate and inexpensive.
Functional anatomic reconstruction of the cardia.
Experiments on bastard dogs have shown that cardia reconstruction using an omega sling is effective. This sling is a pedicled, extramucosally excised, longitudinal muscle flap from the ventral aspect of the greater gastric curvature, which is prestretched at least 100%, wrapped around the cardia twice and sutured to the posterior gastric wall. A physiological pressure gradient is created with the help of intraoperative manometry. Perfusion manometry, radiology, histology and microangiographs demonstrate the competence of the omega sling.
[Spontaneous motility of the human taenia coli under morphine, thiopental and dehydrobenzperidol].
Intestinal dysfunction is well known after narcotic analgesics and anaesthetics. The site and extent of this action is not really known in man. We investigated the direct effect of morphine, thiopentone and droperidol on human taenia libera in vitro. The spontaneous motility of strips of fresh resected human taenia libera induced by a suitable preload was observed by isometric measurement of developed tension. Cumulative doses of morphine 1 X 10(-8) - 3.89 X 10(-6) g/ml, thiopentone 2.5 X 10(-6) - 9.75 X 10(-5) g/ml or droperidol 2.5 X 10(-8) - 9.72 X 10(-6) g/ml were added to the bath solution. The following parameters were analysed: amplitude, frequency and performance (Montevideo Units MU) of the spontaneous contractions and also the basal tone between contractions. Morphine showed no effects. Thiopentone reduced basal tone to 45.5% of the initial value and frequency to zero. The amplitude of contractions and the MU decreased with thiopentone more than 22.5 X 10(-6) g/ml. All effects are reversible. Droperidol has no significant effects with the exception of a light increase of frequency in high doses. The well known in vivo effect of morphine is therefore not induced by direct action on the smooth muscle of human intestine. Thiopentone in high dose can reduced intestinal motility by direct action on the smooth muscle. Droperidol in the dose used is probably without clinical relevance.
Experimental and clinical studies on continent colostomy.
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[Halothane and spontaneous motility of human taenia libera in vitro (author's transl)].
Isolated human taenia libera shows spontaneous motility in the organ bath. The active basal tone, force development and frequency of spontaneous contractions and total power parameter "Montevideo Units" were first analysed under control conditions. Halothane lowered the active basal tone, frequency and the total power of the muscle strip in a dose-dependent manner. The amplitude and force of contraction of human taenia libera first began to increase under halothane, attaining its maximum at 1.0 vol.%. Halothane concentrations above 1.5 vol.% at first caused a depression and finally abolished spontaneous motility. The changes in the spontaneous motility pattern brought about by halothane were completely reversible. Possible causes for the halothane effect were considered as to the possible relevance to the in vivo situation.