[Comment on the contribution by A. Aschoff et al., Neurochirurgia 32 (1989) 10-15: Safe placement of atrial shunt catheters using intracardial ECG].
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Cerebrospinal Fluid Shunts↗
Biomedical subjects
B Panning
Publications and source records attributed to B Panning.
Short term volume effects of a hypertonic saline bolus during neurosurgery.
Intracranial hypertension which does not respond to customary hyperosmotic agents may successfully be treated with hypertonic saline. The absence of diuresis and the maintainance of intravascular volume are supposed to be the main advantages of hypertonic sodium chloride. Volume overload and toxic hyperosmolality from frequent application of such solutions are possible disadvantages. The presented experiments checked the time course of intravascular volume shifts after a 100 ml 1-molar saline bolus in 14 patients during neurosurgery using plasma protein concentration changes. An initial intravascular volume expansion of about 270 ml remained quite unchanged for the first 8 minutes, followed by a nearly linear decrease. Extrapolation of the curves demonstrated that the preinfusion state would have been reached after about 20 minutes. Osmolality remained increased by about 4 mosmol/kg 15 min after the bolus. Thus it appears that repetitive infusion of these amounts of hypertonic saline will cause no serious volume overload if 30 minutes intervals are kept, but osmolality should be checked before each bolus.
Adult↗
[Joseph Weiger and the introduction of anesthesia in Vienna].
The first administration of ether in Vienna was performed by Schuh in 1847. 2 days later also von Wattmann used ether for anaesthesia. Approximately at the same time the nowadays nearly unknown dentist Joseph Weiger began to give ether anaesthesia for dental surgery. He reported in 1850 about his experiences in more than 21,000 operations. A further publication in 1851 gave a survey about the known ether literature.
Anesthesia, Dental↗
[Inner ear deafness following lumbar puncture. A complication requiring patient education?].
Deafness after lumbar puncture has been reported occasionally. Until now this complication has been regarded as spontaneously reversible, but a more recent publication of three cases of irreversible hearing loss possibly caused by lumbar puncture casts doubt on this. It has been proposed that this complication should be included in the pre-operative information given to patients, but we oppose this proposal.
Deafness↗
Determination of circulating blood volume by measurement of indocyanine green dye in hemolysate: a preliminary study.
In 8 emergency care patients blood volume was determined using Cr5I labelled erythrocytes and indocyanine green (ICG). Prior to measurement of ICG in blood with a spectrophotometer, the blood was hemolyzed with Triton-X. A close correlation of r = 0.97 between the Cr51 and the ICGTR-X estimates was found; the ICGTR-X volume was about 3% lower than the Cr51 volume. In five additional in vitro experiments the ICGTR-X method was found to reflect real volumes with an insignificant error of less than 1%. Blood volume determination with ICGTR-X cannot be applied in cases of circulatory failure. ICG should be administered in a dose of 0.5 mg/kg of body weight. For calibration purposes, a two point calibration curve (point 1: point of intersection of x and y axis; point 2: 5 mg ICG/1 of blood) is sufficient. From these preliminary experiments it is concluded that the ICGTR-X method is a rapid and simple technique of blood volume determination with multiple reproducibility which can be carried out in any clinical laboratory.
Blood Volume Determination↗
[Cerebral perfusion pressure in acute blood pressure decrease with hyperosmolar sorbitol in anesthesia conditions].
Osmotherapy with sorbitol during intracranial surgery caused a significant decrease in arterial blood pressure. It was shown that this sometimes very desirable reaction did not cause relevant decreases in cerebral perfusion pressure, but was on the contrary accompanied by an increase in cerebral perfusion pressure in patients with severely elevated ICP (greater than 30 mmHg). 8 patients were studied by measuring the arterial and intracranial pressure during intraoperative infusions of sorbitol 40% (3 ml/kg body weight). Our findings are explained by the simultaneous decrease in arterial and intracranial pressure. During intracranial surgery sorbitol can be used as the antihypertensive agent of choice for treating hypertensive dysregulation of arterial blood pressure in the initial phase of craniotomy before opening the dura.
Anesthesia, General↗
[99 years of morphologic evolution of the spinal cannula].
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Anesthesia, Spinal↗
Regulation of cellular genes transduced by herpes simplex virus.
Previous studies demonstrated that the rabbit beta-globin gene is transcribed from its own promoter and regulated as a herpes simplex virus (HSV) early gene following insertion into the early HSV thymidine kinase gene in the intact viral genome (J. R. Smiley, C. Smibert, and R. D. Everrett, J. Virol. 61:2368-2377, 1987). We report here that the beta-globin promoter remained under early control after insertion into the late HSV gene encoding glycoprotein C. On the basis of these findings, we concluded that the beta-globin promoter is functionally equivalent to an HSV early-control region. We found that a transduced human alpha-globin gene was also regulated as an early HSV gene, while two linked Alu elements mimicked the behavior of HSV late genes. These results demonstrate that certain aspects of HSV temporal regulation can be duplicated by cellular elements and provide strong support for the hypothesis that the regulation of HSV gene expression can occur through mechanisms that do not rely on recognition of virus-specific temporal control signals.
Animals↗
[Chronic subdural hematoma following spinal anesthesia].
A chronic subdural hematoma was observed 4 weeks after spinal anesthesia. The 70-year-old patient complained of severe, long-lasting headache soon after lumbar puncture. The later symptoms of hemiparesis and aphasia were first misinterpreted as a cerebral vascular accident. After evacuation of the hematoma the patient recovered. Long-lasting, severe headaches after lumbar puncture may be caused by a chronic subdural hematoma, a very rare complication. Risk groups are elderly patients and alcoholics, but every age group can be affected, including parturient women who deliver under spinal anesthesia. The diagnostic procedure of choice is computerized tomography (CAT). The application of contrast medium might be necessary if the CAT scan appears suspicious for a hematoma with the same density as the brain tissue. Because this complication is so rare informing the patient before spinal anesthesia does not seem to be necessary. According to expert opinions, a connection between lumbar puncture and subdural hematoma should be possible. In elderly patients and alcoholics, a pre-existing subdural hematoma may be possibly present.
Aged↗
[Photoplethysmography evaluation of collateral blood flow before puncture of the dorsalis pedis artery].
Prior to cannulation of the dorsalis pedis artery the collateral circulation through the plantar arch should be examined to evaluate the consequence of an occlusion of this artery. Since the performance of the Allen's test is impossible for assessment of the plantar arch, another suitable technique has to be chosen. We selected the photoelectric plethysmography. Toe pulses were recorded with photoelectric plethysmography in 20 neurosurgical patients. The pulse amplitudes were measured before and during successive compression of the dorsalis pedis and the posterior tibial artery. Obvious decrease or absence of the pulse wave during compression of the dorsalis pedis artery is indicating an inadequate collateral circulation and cannulation of this artery seems not to be safe. In our study this occurred in 4 of 32 examined feet (12.5 percent). The photoelectric plethysmography has proved to be a simple and accurate means for assessment of collateral circulation.
Adult↗