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Biomedical subjects

C Krier

Publications and source records attributed to C Krier.

At least 19 recordsLinked to original sources
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

[Acute angioneurotic edema due to ACE inhibitors].

Acute angioneurotic edema due to angiotensin converting enzyme (ACE) inhibitors usually develops shortly after therapy has been started. In this case, hypopharyngeal edema occurred with a delay of nine days. It required endotracheal intubation and could only be differentiated from an inflammatory process by examination under general anesthesia. The mechanism of action of ACE inhibitors, the pathogenesis of angioneurotic edema, its therapy outside as well as in the hospital, and the case described are being discussed. It is concluded that severe reactions induced by ACE inhibitors must be expected even after considerable time of therapy.

Acute Disease↗
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↗
PubMed1991

[Intubation problems of anesthesia in otorhinolaryngology].

Many pathological changes in pharynx and larynx can cause problems in endotracheal intubation. Their preliminary signs and symptoms are often uncharacteristic. Thus prophylaxis is not always possible. Some representative diseases of larynx and pharynx are demonstrated by means of endoscopic photographs and by case reports. The photos were taken during endoscopic examinations in an ENT-clinic. The method of anaesthesia used in these cases is described, as well as prophylactic measures to be taken, if a difficult intubation may be expected. Finally, the procedure in case of an unexpected critical intubation is discussed.

Adult↗
PubMed1991

[Decrease in the concentration of tobramycin, vancomycin and phenobarbital in administration with infusion filter].

To assess the loss of drugs to in-line filters, concentrations of tobramycin, vancomycin, and phenobarbitone were determined in vitro in samples recovered upstream and downstream of the filter. Binding of the drugs to new filters was higher than to used filters. With bolus administration, the concentrations of vancomycin and phenobarbitone were reduced by 1% when using old filters and by 4% when using new filters. Tobramycin concentrations were reduced by 7 and 12%, respectively. With continuous administration of the drugs, binding was highest during the first half hour. Differences between new and used filters were also seen with continuous administration: The cumulative loss was 5% higher with new than with old filters. This difference in binding between filters may stem from a saturation of free binding sites. Tobramycin showed the highest binding to the in-line filter. The extent of adsorption of tobramycin to intravenous filters may be considered moderately important in adult patients. The adsorption of vancomycin and phenobarbitone is not clinically relevant in adult patients.

Adsorption↗
PubMed1991

The influence of etomidate upon cerebral metabolites after complete brain ischaemia in the rat.

The influence of etomidate on post-ischaemic cerebral metabolism was examined in 1-year-old male Wistar rats. Ten rats were randomly allocated to each of three groups. Group 1 animals received etomidate for 60 min without undergoing cerebral ischaemia. In Group 2, there was a 60-min recovery period following 15 min of complete cerebral ischaemia. Etomidate was administered to Group 3 animals after 15 min of ischaemia. At the end of the study period, the brains were frozen in situ using liquid nitrogen. The cortex was then biochemically analysed. Considering glycolysis as well as the citric-acid cycle, the pattern of metabolite changes with etomidate application was almost identical to the pattern of spontaneous recovery. The content of energy-rich phosphates was reduced when Groups 2 and 3 were compared with the non-ischaemia group, indicating previous depletion of energy reserves of brain tissue. However, the energy charge as a parameter of energy balance had already been returned to normal values. We conclude that post-ischaemic application of etomidate has no favourable effect on recovery after complete cerebral ischaemia in the rat.

Animals↗
PubMed1990

[Continuous intragastric pH measurement in intensive care patients treated with ranitidine and tube feeding].

We studied 22 critically ill patients on long-term mechanical ventilation using continuous intragastric pH monitoring with an antimony electrode. Intragastric pH profiles were established for the duration of mechanical ventilation (mean: 7 days). The aim of our study was to achieve a gastric pH between 3.0 and 4.5 utilizing the H2-receptor antagonist ranitidine and nasogastric feeding with Nutricomp F. Patients were divided into three groups which were given (A) ranitidine boluses, (B) continuous ranitidine infusions, or (C) continuous ranitidine infusions together with enteral nutrition via the nasogastric tube. In group B we were able to obtain a pH value between 3.0 and 4.5 only in 11.6% of the observation period. With ranitidine boluses, there were even less measurements (9.3%) in the "optimal" pH range. The combination of continuous ranitidine application together with enteral alimentation made our attempts slightly more successful (20.0%). This failure to achieve the desired pH range encourages airway colonisation and nosocomial pneumonia at gastric pH greater than 4.5. At pH less than 3.0 there is a significantly higher incidence of acute stress ulcerations. Other therapeutic regimens e.g. the application of pirenzepine and sucralfate offer adequate protection of the gastric mucosa without raising the pH level.

Adult↗
PubMed1989

Serum aluminium levels of intensive care patients treated with two different antacids for prevention of stress ulceration.

We studied the serum aluminum levels of 30 intensive care patients receiving six daily doses of magaldrate (Riopan) or aluminium hydroxide (Trigastril). In both groups we found a significant rise of the serum aluminium concentration (p less than 0.01) following administration of the antacid solutions. Examination on day 9 and 15 the magaldrate group showed significantly (p less than 0.05) lower aluminium levels than the aluminium hydroxide group. An increase up to the critical serum aluminium level of 100 ng/ml occurred in none of the patients that all had normal or slightly impaired renal function. Therefore routine measurements of serum aluminium levels in patients without renal impairment are not considered necessary following antacid therapy. However, we recommend the use of antacids with an aluminium absorption rate as low as possible.

Adult↗
PubMed1989

[Contamination of respirators in long-term ventilation].

The role of artificial ventilation as an exogenous source of nosocomial pneumonia in long-term ventilated patients is well established. Hence, decontamination of respirators after use is inevitable, although this procedure is costly and time-consuming. The purpose of the study was to prove the efficacy of bacterial filters (Ultipor BB 50, Pall Ltd., Dreieich) in preventing microbial contamination of respirators during long-term ventilation. We investigated the impact of the patient tracheal flora on different parts of the ventilation system. A total of 30 patients included 9 patients treated with an aminoglycoside intratracheally and whose ventilators were equipped with breathing system filters, 10 patients treated with the aminoglycoside intratracheally and without filters, and finally 11 patients without antibiotic prophylaxis and without filters. 1495 samples were taken from different parts of the ventilation circuit. The data obtained suggest that there is no significant influence on the contamination rate of the ventilators by application of bacterial filters or intratracheal aminoglycoside. The use of the breathing system filters to protect the ventilator from microbial contamination, therefore, seems to be unnecessary.

Adolescent↗
PubMed1989

[Adequate respiratory therapy in polytrauma in the prehospital phase by pulse oximetry monitoring].

As a result of recent medical development, the pulse oximetry enables the emergency-doctor to carry out an objective and continuous respiratory monitoring. In a prospective study we showed the consequences of this new procedure for prehospital respiratory therapy and the following posttraumatic development of polytraumatized patients. In 1988 within 6 months we carried out a continuous monitoring of 13 severely polytraumatized patients in the prehospital period using the pulse oximeter Nellcor N-10 and Pulsat. In order to see the posttraumatic respiratory complications, we studied the respiratory therapy of the following 3 days as well as the course of disease until the patients' release of the hospital. 38% of the patients were intubated immediately after the accident and further 12% before arriving at the hospital. The oxygen inhalation therapy of 63% spontaneously breathing patients and the mechanical ventilation patterns of 80% of the ventilated patients were modified in the prehospital period, because 60% of the patients with standard mechanical ventilation showed hypoxygenations. During the first 3 posttraumatic days 23% of the patients died the the number of mechanical ventilated patients increased from 46% to 54% because of surgical interventions. A respiratory therapy of more than 3 days was applied on 40% of the surviving patients, with 20% receiving mechanical ventilation. Thereby no primarily respiratory complications could be seen. While not being decisive for immediate intubation, monitoring with a pulse oximeter used by the emergency-doctor plays an essential part in carrying out an effective control and dosage of the therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗