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Biomedical subjects

D Kettler

Publications and source records attributed to D Kettler.

At least 73 records · Page 4Linked to original sources
PubMed1994

[TIVA with etomidate-fentanyl versus midazolam-fentanyl. The perioperative stress of coronary surgery overcomes the inhibition of cortisol synthesis caused by etomidate-fentanyl anesthesia].

Etomidate is a hypnotic with only minor effects on haemodynamics. Although its rapid elimination kinetics would suggest its use in total intravenous anaesthesia (TIVA) and sedation, its administration in higher doses or for a prolonged period has been discouraged due to its inhibitory effects on corticosteroid synthesis. Newer evidence that the suppression of cortisol synthesis might not be total requires a re-evaluation of this drug as a component of a TIVA technique. The effects of high-dose etomidate with fentanyl on spontaneous and stimulated corticosteroid levels as a measure of the magnitude and duration of adrenocortical suppression, as well as on plasma concentrations of adrenocorticotropic hormone (ACTH) beta-endorphin, and catecholamines during cardiac surgery were investigated in a prospective, randomised study and compared to those following the administration of midazolam-fentanyl. PATIENTS AND METHODS. Nineteen patients undergoing myocardial revascularisation were assigned to two groups: group 1: etomidate-fentanyl (n = 9) and group 2: midazolam-fentanyl (n = 10). Anaesthesia was induced with fentanyl 0.5 mg and either etomidate 0.3 mg/kg or midazolam 0.2 mg/kg. Relaxation was achieved with pancuronium 0.1 mg/kg. Anaesthesia was maintained during extracorporeal circulation (ECC) with an infusion of etomidate (0.36 mg.kg-1.h-1) or midazolam (0.16 mg.kg-1.h-1) and fentanyl 10 micrograms.kg-1.h-1. Blood samples were drawn before induction, before ECC, and 1, 6, and 20 h after surgery. Cortisol secretion was stimulated with 0.25 mg ACTH1-24 IV at 6 and 20 h postoperatively. RESULTS. The total drug doses were etomidate 87 +/- 3 mg and midazolam 46 +/- 2 mg. Plasma cortisol concentrations decreased in the etomidate group from 20 (10-31) to 10 (6-31) micrograms.dl-1 (median and range) before ECC, but had returned to baseline at 1 h and were significantly increased at 6 h [29 (15-47) micrograms.dl-1] and 20 h [46 (29-62) micrograms.dl-1]. There was no difference between the groups except at 20 h, when cortisol levels were higher in the etomidate group. The stimulated cortisol increase was markedly impaired in this group at both measuring points. ACTH and beta-endorphin were markedly increased in the etomidate group and ACTH concentrations were eight times greater than the corresponding values in the midazolam group after surgery (ACTH 141 vs. 18 pmol.l-1). Plasma catecholamine concentrations increased significantly in both groups. Noradrenaline concentrations were greater in the etomidate group at 6 h after surgery. Two patients in the midazolam group and none in the etomidate group required circulatory support with exogenous catecholamines. DISCUSSION. It is concluded that the stress of cardiac surgery can overcome the block in cortisol synthesis caused by the administration of high-dose etomidate by substantially increasing ACTH secretion. The administration of high-dose etomidate was not associated with cardiovascular instability. The use of etomidate as a component of TIVA can therefore not be ruled out on the grounds of insufficient cortisol secretion.

Adrenocorticotropic Hormone↗
PubMed1994

[Inverse fick's principle in comparison to measurements of oxygen consumption in respiratory gases. Does intrapulmonary oxygen uptake account for differences shown by different system methods?].

Automated measurements of respiratory gas exchange recently became available for the determination of oxygen uptake (VO2) in critically ill patients. Whereas these metabolic gas monitoring systems (MBM) are assumed to measure total body VO2, the reversed Fick method in principle excludes intrapulmonary VO2. Previous clinical reports comparing VO2 measured by the reversed Fick principle (VO2Fick) with VO2 measured by MBM (VO2MBM) found that VO2MBM was significantly greater than VO2Fick. It was suggested that these differences between methods represent VO2 of pulmonary and bronchial tissue, as intrapulmonary VO2 had been estimated to account for 15% of total body VO2 in dogs with experimental pneumonia. The objective of this study was to compare VO2Fick with VO2MBM in patients with and without pneumonia and to assess the reproducibility of both methods in critically ill patients. METHOD. With institutional approval nine critically ill patients with acute pneumonia were studied under controlled mechanical ventilation. The diagnosis of pneumonia was based on respective changes of chest X-rays, body temperature > 38 degrees C, and WBC counts > 12,000/mm3. Inspiratory oxygen fractions (FIO2) ranged from 0.3 to 0.6; all patients routinely received opioids and hypnotics. Complete muscle relaxation was achieved during the periods of measurement to avoid sudden changes in VO2 due to shivering or involuntary movements. Arterial and pulmonary-arterial blood samples were drawn simultaneously after aspiration of the sevenfold catheter dead space. Measurements of haemoglobin concentration (Hb), fractional oxygen saturation (SO2), and O2 partial pressure (PO2) were performed by use of a calibrated haemoximeter and blood gas analyser, respectively; 2 x 5 thermodilution measurements of cardiac output (CO) were spread randomly over the respiratory cycle for each determination of VO2Fick. To minimise systematic errors of CO measurements, the CO computer was calibrated in an extracorporeal flow model using an electromagnetic flowmeter. Calculations of VO2Fick were based on an oxygen binding capacity of 1.39 ml/g Hb. Simultaneous measurements of VO2MBM were obtained by use of a Datex Deltatrac MBM that had been validated in vitro with a gas dilution model of respiratory gas exchange. Calibration of the MBM was performed prior to each measurement. Gas supply of the respirator was provided by an external high-precision mixing device to reduce errors in VO2 measurements that may arise from short-term oscillations in FIO2. All patients with pneumonia were studied on three consecutive days; thus, measurements from 27 days could be analysed. On each day two sets of measurements were performed at an interval of 60 min to assess the reproducibility of differences between methods. During each set of measurements duplicate blood samples were drawn twice, before and after thermodilution measurements of CO, to evaluate the short-term repeatability of VO2Fick. The beginning and the end of each set of measurements were marked in the computer record of the MBM to assess the respective repeatability of VO2MBM. Fifty control measurements were performed in ten patients undergoing major neurosurgical procedures. None of these patients exhibited signs of pulmonary infection. Except for the number of repeated measures, all VO2 measurements were obtained in the same way as in the study group. Descriptive statistical analysis was performed according to Bland and Altman; comparisons between methods were done by multivariate analysis of variance for repeated measures. RESULTS. Neither in the study group nor in the control group could a significant difference between methods be demonstrated. In patients with pneumonia the mean difference between methods (VO2Fick-VO2MBM) was 15.2 ml/min (4.2%); the double standard deviation of differences (2 SD) was 59.2 ml/min (19.2%).

Blood Gas Analysis↗
PubMed1994

Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.

UNLABELLED: In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group? METHODS: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories. RESULTS: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis. CONCLUSIONS: In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.

Cardiopulmonary Resuscitation↗
PubMed1994

Effect of anaesthesia on the cytokine responses to abdominal surgery.

Plasma concentrations of interleukins, particularly IL-6, increase after trauma and surgery. We have undertaken this study to see if the choice of anaesthetic directly or indirectly influences cytokine release. Twenty women (ASA I-II, aged 26-60 yr) undergoing elective hysterectomy for non-malignant disease were allocated randomly to receive either inhalation anaesthesia with isoflurane and nitrous oxide (group 1), or total i.v. anaesthesia with alfentanil and propofol (group 2). Blood samples for measurement of interleukins IL-1 beta and IL-6, and cortisol and prolactin concentrations were obtained at intervals from before induction to 6 h after surgery. IL-1 beta concentrations did not change during the study. IL-6 increased significantly in both groups (P < 0.05). The IL-6 increase in group 1 began earlier than in group 2. Median IL-6 concentrations were greater in group 1 (median 62 (range 0-214) pg ml-1 vs 46 (0-220) pg ml-1) (P < 0.01). Cortisol concentrations increased more rapidly and reached greater maximum concentrations in group 1. Prolactin concentrations increased immediately and to the same degree after induction in both groups, but were greater in group 2 after operation. We conclude that anaesthesia with alfentanil and propofol diminished release of IL-6 in response to abdominal surgery compared with isoflurane and that this reduction was an effect of alfentanil.

Adult↗
PubMed1994

The influence of anesthesia on myocardial oxygen utilization efficiency in patients undergoing coronary bypass surgery.

A maximum efficiency of myocardial oxygen utilization is desirable, especially in patients with limited coronary blood supply. Little is known about the effects of anesthesia on the efficiency of myocardial oxygen utilization. The aim of this retrospective study was to investigate the effects of different types of anesthesia on myocardial efficiency in patients undergoing coronary bypass surgery. Myocardial blood flow (Argon wash in technique), myocardial oxygen uptake, and standard hemodynamics were measured awake, after induction of anesthesia, and during sternal spread. Myocardial oxygen utilization efficiency was calculated from the ratio of external work divided by myocardial oxygen consumption. Sixty-five patients in eight groups with different anesthetic techniques were studied: 1) halothane/nitrous oxide, 2) enflurane/nitrous oxide, 3) high-dose morphine, 4) high-dose fentanyl, 5) fentanyl/midazolam, 6) high-dose sufentanil, 7) sufentanil/nitrous oxide, and 8) propofol. In all groups induction of anesthesia was associated with a decrease of cardiac work (from 86 +/- 17 to 55 +/- 16 J/min in pooled data) which resulted from a decrease of both stroke volume index and blood pressure. However, myocardial oxygen consumption did not decrease proportionally (from 11.2 +/- 3.0 to 8.5 +/- 2.3 mL.min-1 x 100 g-1 in pooled data) and myocardial oxygen utilization efficiency was therefore decreased in all groups (from 29.2% +/- 2.5% at awake state to 23.9% +/- 5.8% after induction of anesthesia in pooled data). Surgical stimulation by sternotomy and sternal spread was associated with different patterns of hemodynamic response between groups. Blood pressures and external work tended to be higher in the high-dose narcotic groups while it remained less affected in the other groups. However, myocardial efficiency remained depressed in all groups (22.2% +/- 8.2% in pooled data) and with respect to myocardial efficiency no differences between anesthetic techniques were found. We conclude that the specific anesthetic technique does not influence impairment of myocardial oxygen utilization efficiency by anesthesia.

Anesthesia↗
PubMed1994

Total intravenous anaesthesia with sufentanil-midazolam for major abdominal surgery.

Haemodynamic and endocrine stress responses were compared during total intravenous anaesthesia with sufentanil and midazolam or fentanyl and midazolam in patients undergoing elective major abdominal surgery. Twenty-two ASA I and II patients were allocated randomly to receive sufentanil (induction 1.5 micrograms kg-1 plus infusion 1.5 micrograms kg-1 h-1) or fentanyl (induction 10 micrograms kg-1 plus infusion 10 micrograms kg-1 h-1) supplemented with 0.15 microgram kg-1 sufentanil or 1 microgram kg-1 fentanyl as necessary. Midazolam was infused to obtain plasma concentrations of 500-600 ng ml-1. Ventilation was with oxygen-enriched air. The opioid infusion was reduced post-operatively by half and benzodiazepine effects were reversed by titration with flumazenil. Mean arterial pressure, heart rate and cardiac index decreased in both groups after induction (cardiac index: sufentanil 4.94 +/- 0.45 to 2.99 +/- 0.18 litre min-1; fentanyl 4.97 +/- 0.45 to 3.71 +/- 0.36 litre min-1), but all returned to baseline during surgery. With sufentanil; mean arterial pressure was lower throughout the study period, and heart rate was lower intra-operatively. Oxygen uptake decreased in both groups after induction (sufentanil 289 +/- 29 to 184 +/- 21 ml min-1; fentanyl 318 +/- 32 to 216 +/- 32 ml min-1) and remained low with sufentanil until flumazenil was given. Adrenaline concentrations increased in both groups but there was no intergroup difference. The median noradrenaline concentration was lower intra-operatively with sufentanil (0.47 nmol litre-1 (range 0.06-6.77)) than with fentanyl (0.73 nmol litre-1 (0.07-4.58)). Cortisol, glucose and lactate concentrations increased in both groups. Bradycardia occurred in four patients with sufentanil and in three with fentanyl. There were two cases of marked thoracic rigidity with sufentanil and one with fentanyl.

Abdomen↗
PubMed1993

Hydrogen peroxide in expired breath condensate of patients with acute respiratory failure and with ARDS.

OBJECTIVE: Measurement of hydrogen peroxide concentrations in breath condensate of mechanically ventilated patients with ARDS and with risk factors for developing ARDS. DESIGN: Open study in intensive care patients. SETTING: Intensive care units of the Clinics of the University of Göttingen, a primary care center. PATIENTS: 10 post-operatively ventilated patients as a control group and 26 patients with acute respiratory failure, 7 of them with ARDS, 12 with polytrauma, 4 with pneumonia, 3 with cardiogenic or nephrogenic pulmonary edema. INTERVENTIONS: None. MEASUREMENTS: Breath condensate was collected by a special cold trap and was analysed for H2O2 by a chemiluminescence method. Daily measurements were performed for 4.2 +/- 2.6 days (mean +/- SD) as soon as possible after manifestation of respiratory failure. RESULTS: Patients with acute respiratory failure exhibited higher H2O2 concentrations than control patients (median 95 nmol/l, range 76-144 nmol/l), with the highest median value found in the ARDS group (552 nmol/l, range 154-893). After clinical improvement, H2O2 concentrations decreased to the range of the control group. CONCLUSION: Since high concentrations of H2O2 in breath condensate were only found in patients with ARDS or with risk factors for ARDS, the results add to the existing evidence that reactive oxygen species are associated with some acute lung diseases.

Adolescent↗
PubMed1993

[Neurolytic block of the lumbar sympathetic trunk in advanced stages of peripheral arterial occlusive disease].

UNLABELLED: Neurolytic blocks of the lumbar sympathetic trunk enable a less invasive sympathetic denervation if compared to standard surgical procedures. METHODS: 34 patients undergoing chemical lumbar sympathectomy (CLS) for advanced arterial occlusive disease were prospectively studied. An actual indication for reconstructive vascular surgical intervention had been excluded in all patients. The sympatholytic efficacy, different haemodynamic variables, the relief of rest pain and the effect on ischaemic ulcers were quantified before, 3 and 21 days after CLS. RESULTS: The mean intensity of rest pain, as assessed on a visual analogue scale (0-100 mm), significantly decreased from 60 mm to 31 and 34 mm, respectively. 9 of 12 patients with ischaemic ulcers showed partial or complete remission within the study period. Overall, in 88% of patients sympathetic denervation could be demonstrated by ablation of the sympatho-galvanic skin response. The mean difference in skin temperature between the treated and the untreated leg significantly increased from -0.73 degrees C to +0.34 and +0.39 degrees C, respectively. Doppler-sonographic measurements of the ankle-pressure-index showed a minor increase from 0.34 to 0.36 and 0.42; however, these changes did not reach significance. Neither changes of the different physiologic variables nor data of the patient history could predict the relief of rest pain after CLS. The only side effect of CLS was transient neuralgia of the genitofemoral nerve occurring in 19% of patients. CONCLUSION: Considering the relatively short follow-up period, the results of this study support evidence of the therapeutic efficacy of CLS for rest pain and ischaemic ulcers in patients with advanced arterial disease. The prognostic value of standard variables for estimation of sympathetic reactivity and skin blood flow, however, could not be confirmed.

Aged↗
PubMed1993

Effects of etomidate on the adrenocortical and metabolic adaptation of the neonate.

The effects of etomidate on corticosteroid synthesis were compared with those of methohexitone. We studied 40 neonates, 22 delivered by elective and 18 by emergency Caesarean section. Apgar scores, blood sugar and plasma concentrations of cortisol and etomidate were evaluated at birth and 2 and 6 h postpartum. There was no difference in Apgar scores attributable to the induction agent. The median cortisol concentrations in cord blood were small (136 nmol litre-1; range 47-478 nmol litre-1, and 259 nmol litre-1; range 58-1504 nmol litre-1 after elective and emergency sections, respectively). During the study, cortisol concentrations increased in the infants in the methohexitone groups and decreased in those in the etomidate groups; this effect was most evident 2 h after delivery (methohexitone groups 245 nmol litre-1, range 70-959 nmol litre-1; etomidate groups 121 nmol litre-1, range 56-320 nmol litre-1). There was no difference at 6 h postpartum (methohexitone groups 183 nmol litre-1, range 25-756 nmol litre-1; etomidate groups 190 nmol litre-1, range 33-628 nmol litre-1). The concentration changes during the study period differed significantly (P < 0.005) with respect to the induction agent. Blood glucose concentrations were small (mean (SD) in all 40 neonates 2 h postpartum was 2.64 (0.77) mmol litre-1), and did not differ between the groups. There were 17 cases of moderate to severe hypoglycaemia (blood glucose concentrations less than 2.5 mmol litre-1): nine in the etomidate group and eight in the methohexitone group.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Obstetrical↗
PubMed1993

[Optimization of the image intensifier-assisted technique of lumbar sympathetic block. Computed tomographic simulation of a paravertebral puncture access].

The paravertebral approach is the most common technique for local anaesthetic and neurolytic lumbar sympathetic blocks. However, guidelines on the site of needle insertion differ. As there have been several case reports on accidental trauma to the ureter and the kidney, this study was undertaken to evaluate the site of paravertebral needle insertion and the fluoroscopic landmarks for lumbar sympathetic blocks by computed tomographic puncture simulation. METHODS. CT scans of 73 patients at the level of L2-4 were analysed with respect to the location of kidneys, the vertebral insertion of the diaphragm, the distance of the sympathetic trunk from the ventral and lateral border of the lumbar vertebrae, the paravertebral distance of a tangent from the sympathetic trunk through the kidney surface and the frequency of inadvertent puncture of major organs by different paravertebral approaches. For needle insertion distances of 6, 8, 10 and (at the level of L4) 12 cm lateral to the midline were simulated. RESULTS. Simulating a paravertebral approach of 6 cm resulted in perforation of the right (or left) kidney only at the level of L2 in 1.4% (2.8%) of cases. The incidence of accidental renal puncture due to a paravertebral approach of 8 cm was 26.0%, 4.1% and 0 (26.0%, 2.7% and 0) at the levels L2, L3 and L4, respectively. A more lateral insertion of needles 10 cm from the spinous process increased the frequency of anticipated renal puncture to 57.5%, 19.2% and 1.4% (65.8%, 26.0% and 1.4%); in addition, perforation of liver parenchyma was detected in two cases. Although the lower pole of the kidney reached the mid-vertebral level of L4 in only 23.3 (15.1)% of cases, a lateral approach 12 cm from the midline still showed a 8.2 (4.1)% incidence of kidney perforation and inadvertent trauma to the intestine in two cases. The mean distance from the sympathetic trunk to the ventral border of the lumbar vertebra (in simulation of a lateral fluoroscopic view) was 0.80, 0.66 and 0.59 cm, analogous measurements to the lateral border averaged 0.37, 0.43 and 0.50 cm at L2, L3 and L4, respectively. At the level of L2 the medial insertion of the diaphragm was identified in 45% of patients in close anatomical relationship to the psoas fascia. CONCLUSION. In order to reduce the risk of accidental trauma to major organs the paravertebral distance of insertion of the needles from the midline should not exceed 6, 7 and 10 cm for lumbar sympathetic blocks at the levels of L2, L3 and L4, respectively. However, a paravertebral approach of less than 6 cm may cause a lateral and ventral deviation of the needle from the sympathetic chain. Under fluoroscopy a correct needle position is obtained at an average distance of 0.5-0.8 cm dorsal to the anterior vertebral border, advancing the needle to the ventral border may cause an accidental puncture of the vena cava in more than 20% of patients undergoing nerve block of the right sympathetic chain. Furthermore, at the level of L2 inadvertent placement of the needle tip within the vertebral insertion of the diaphragm must be considered as a reason for atypical spread of contrast medium.

Anesthesia, Spinal↗
PubMed1993

[Postoperative analgesia--a comparative study in laparoscopic cholecystectomy and lower abdominal laparotomy].

From September 1992 through February 1993 27 randomly chosen female patients were evaluated for differences in postoperative pain intensity (as determined by visual-analogue-scale (VAS)) and analgesic requirements via patient-controlled-analgesia (PCA), either after open lower-abdominal-laparotomy (n = 16, group 1) or after minimal-invasive-cholecystectomy (n = 11, group 2). The type of anaesthesia has been standardized, either as balanced or total intravenous anaesthesia. There were no statistically significant differences between the groups regarding to age, height, weight, intraoperative anaesthetic drug consumption, or duration of anaesthesia and surgery (205.6 vs 185.5 minutes; 139.1 vs 105.0 minutes). All patients could be extubated while still in the operation theatre. The 10-hour study period started after transfer to the recovery room. Heart- and respiratory-rate, systolic/diastolic blood pressure, endtidal pCO2, oxygen-saturation via pulsoxymetry (SaO2), and demands from PCA-pump were recorded, furthermore pain scores were determined every hour. The VAS-scores showed no significant differences between the two groups. The pain level as a whole was low, with the scores ranging from a maximum of 23.4 mm (group 1 after the first hour) to a minimum of 1.8 min (group 2 after 5, 8 an 10 hours). The overall analgesic requirements differed significantly (37.7 vs 17.3 mg piritramid, p < .01). There was a difference throughout the whole study period, although statistically significant only at the 1., 2. (p < .05), 5. and 6.-8. hour (p < .01). This study showed that pain scores were similar after laparoscopic upper or open lower abdominal surgery, both requiring adequate analgesic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Specifics of anesthesiology in laparoscopic surgery in infancy].

No data exist in the literature pertaining to the problems of laparoscopic surgery in infants and children. However it is reasonable to assume that minimal invasive surgery will find increasing application in these patients in the future. The anesthesiological problems met during surgery are representatively demonstrated and discussed in the context of a case report. It is shown that in infants a reduction of functional residual capacity due to the pneumoperitoneum and consequently increased intraabdominal pressure (IAP) cause alveolar collapse, increased venous admixture and oxygen desaturation more rapidly than in adults. This can be prevented by ventilating with a sufficient level of PEEP. On the other hand, the reduction of venous return caused by increased IAP and aggravated by the necessarily high PEEP can compromise circulation. Adequate volume substitution is essential.

Anesthesia, General↗
PubMed1993

[Interleukin-1 beta and interleukin-6-plasma concentrations in laparotomies. Interaction with neuroendocrine secretion and postoperative temperature regulation?].

Elevated body temperature, increased plasma cortisol concentrations, and loss of the circadian secretory pattern are typical changes observed after trauma and surgery. We investigated the hypothesis that the interleukins IL-1 beta and IL-6 are involved in these phenomena, since both are endogenous pyrogens and can induce ACTH and cortisol secretion. METHODS. Eight healthy women undergoing hysterectomy for non-malignant diseases participated in the study after having given written consent. The study had the approval of our institution's ethics committee. Anaesthesia was induced with fentanyl 0.1 mg and methohexitone 1.5 mg/kg and maintained with isoflurane in 60% N2O and 40% O2. Blood samples were drawn before induction, before incision, during surgery, at the end of surgery, and 30, 60, 120, 240 and 360 min after surgery. Cortisol, prolactin, IL-1 beta, and IL-6 concentrations were determined with commercially available ELISAs. Statistical analysis was performed with non-parametric methods. RESULTS. IL-6 increased significantly from 15 (4.3-23) to 68 (18-107) pg/ml (medians and range) at the end of surgery and peaked at 128 (52-214) pg/ml 60 min postoperatively (p < 0.01, Table 2). Baseline IL-1 beta concentrations were 20 (1-35) pg/ml with a significant increase in median postoperative concentrations in the postoperative period (p < 0.001). Prolactin increased from 22 (13-43) to 210 (115-291) ng/ml immediately after induction of anaesthesia (p < 0.001) and remained elevated until 240 min after surgery. Cortisol increased from 99 (26-167) to 384 (241-553) ng/ml during surgery and reached a maximum of 475 (246-597) ng/ml 30 min postoperatively (Table 3). Rectal and mean body temperatures increased significantly in the postoperative period (Table 1). There was a significant correlation between IL-6 and cortisol concentrations (r = 0.468; p < 0.001), but none was found between IL-6 and temperature or between IL-1 beta and cortisol or temperature. CONCLUSIONS. Surgical trauma markedly stimulates the secretion of IL-6, and to a lesser extent that of IL-1 beta. The data do not yield any evidence indicating an effect of IL-1 beta or IL-6 on body temperature. Postoperative prolactin concentrations might be influenced by IL-6. The positive correlation between plasma concentrations of IL-6 and cortisol may be coincidental, but could reflect a causal relationship, particularly in the postoperative period during which time the circadian pattern of cortisol secretion is disturbed.

Body Temperature↗
PubMed1993

[General anesthesia in two patients with mitochondrial myopathy].

Two patients with mitochondrial myopathy (Kearns-Sayre syndrome) received general anaesthesia. In the first case propofol-alfentanil anaesthesia was carried out; the second patient received propofol-fentanyl anaesthesia. Muscle relaxation was provided with vecuronium. In both cases we observed a short episode of bradycardia (heart rate < 50.min-1), which was successfully treated with atropine. After the propofol infusion had been stopped, both patients rapidly gained consciousness and were extubated after prompt spontaneous ventilation had returned. Reversal of neuromuscular blockade in the second patient was achieved within 5 min by neostigmine. Special anaesthetic problems in patients with mitochondrial myopathies such as myocardial conduction disturbances, postoperative muscle hypotonia, and possible increased susceptibility to malignant hyperthermia can be overcome by the described anaesthetic management.

Adult↗