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Biomedical subjects

E Kirchner

Publications and source records attributed to E Kirchner.

At least 19 recordsLinked to original sources
PubMed1999

Postoperative pattern of various hormonal and metabolic variables. A pilot study in patients without complications following cardiac surgery.

The use of single predictors for threatening postoperative complications are widely accepted. However, a typical pattern of multiple parameters could be more helpful than a single predictor. To study this hypothesis, various variables of normal postoperative changes in patients without postoperative complications were investigated. Secondly, this pattern needs to be compared in the future with those findings in patients with postoperative complications. Blood parameters of 13 patients undergoing cardiovascular surgery without postoperative complications for 24 hours were evaluated. Samples were obtained on the afternoon before the operation and 1, 3, 6, 12 and 24 hours after the end of surgery. At one hour postoperation increased levels of the following parameters were noted: growth hormone (p < 0.0001), glucose (p < 0.0001), insulin (p < 0.001), c-peptide (p < 0.001), lactate (p < 0.002), glutamate (p < 0.0001), aspartate (p < 0.001) and total amino acids (p < 0.05), although the concentration of some amino acids decreased. Three hours postoperatively free fatty acids (p < 0.05) were increased. Total-T3 concentrations were reduced postoperatively. Other parameters were not altered. Most of the parameters returned to normal values during the period of observation.

Aged↗
PubMed1997

[Endocrine reactions, circulatory and resuscitation behavior in ketamine-midazolam anesthesia. A comparative study of ketamine racemate vs. (S)-ketamine in knee surgery].

UNLABELLED: Clinically used ketamine is a racemic mixture of two isomers, (S)- and (R)-ketamine, in equal amounts. Previous investigations showed the anaesthetic potency of (S)-ketamine to be three times higher than that of (R)-ketamine. The aim of this study was to compare the effects of (S)-ketamine/midazolam and racemic ketamine/midazolam on endocrine and cardiovascular parameters, recovery, and side effects in unpremedicated patients during knee surgery. METHODS: 41 patients scheduled for elective knee surgery were investigated in a prospective, double-blind, and randomised design. For induction of intravenous anesthesia, patients received 0.1 mg/kg midazolam, 0.003 mg/kg atropine, 1 mg/kg (S)-ketamine or 2 mg/kg racemic ketamine, respectively. For tracheal intubation, 1 mg vecuronium and 1.5 mg/kg suxamethonium were injected. After intubation and relaxation with a total dose of 0.1 mg/kg vecuronium, a continuous infusion of 0.5 mg/kg/h (S)- or 1 mg/kg/h racemic ketamine was administered throughout the surgery. In addition, 0.05 mg/kg/h midazolam was infused continuously in both groups throughout surgery. Ventilation was performed with N2O/O2 (FiO2 0.3). Blood samples were taken using a central venous line five times before induction as well as during and after surgery for analysis of adrenaline, noradrenaline (by high-pressure liquid chromatography with electrochemical detection), anti-diuretic hormone (ADH), adrenocorticotropic hormone (ACTH), and cortisol (by radioimmunoassay). In addition, systolic and diastolic arterial pressure (SAP, DAP), heart rate (HR), and arterial oxygen saturation were measured. The time intervals between the end of ketamine and midazolam infusion and the return of consciousness and orientation were recorded. The incidence and quality of dreams and other side effects were reported by the patients. RESULTS: Biometric data of the groups were comparable. Plasma adrenaline and noradrenaline did not change significantly during anaesthesia. ADH increased significantly (p < 0.05) after skin incision in both groups.

Adolescent↗
PubMed1997

In vitro evaluation of a glass-ceramic restorative material.

The aim of the present study was to evaluate the clinically relevant properties of the recently introduced ceramic material IPS Empress, which is marketed for all-ceramic restorations. The following parameters were investigated: three- and four-point bending strength, bi-axial flexure strength, compressive and diametral tensile strength, compressive strength and marginal fit of full crowns. The results show that this material is a highly developed glass-ceramic with physical properties making this dental material well suitable for adhesively luted restorations.

Adhesives↗
PubMed1997

[Effect of lidocaine administration mode on decreasing injection pain caused by propofol].

Pain is a well known complication of propofol injection. Many methods are described to reduce it but often empirical ways are used. In this study we attempt to determine the effects of premixing propofol with lidocaine or to preinjecting lidocaine in a hand vein in combination with using a tourniquet before we applicated propofol. Our study shows that both ways are able to reduce the injection pain but premixing with lidocaine 0.05% is less effective than giving a bolus of lidocaine before the propofol injection.

Anesthetics, Intravenous↗
PubMed1997

[Anesthesiologic characteristics of isolated hyperthermic liver perfusion with mitomycin C].

The isolated hyperthermic liver perfusion with mitomycin C presents a new technique of regional therapy for irresectable liver tumours. The advantage is a high local concentration of the antitumour agent with reduced systemic side-effects. Isolated hyperthermic liver perfusion is an extensive surgical procedure requiring a veno-venous bypass and a heart-lung machine. Disturbances affecting the base-acid hemostasis, the coagulation system and the cardiocirculatory function can occur. To date, there has been little experience with this technique. The intraoperative changes during the isolated hyperthermic liver perfusion in our series were similar to those seen during orthotopic liver transplantation. In contrast to orthotopic liver transplantation, heparin is given during the anhepatic phase. The reperfusion after isolated hyperthermic liver perfusion was not complicated by severe cardiocirculatory changes. A decrease in body temperature was not observed probably due to the absence of cold, potassium-rich perfusate flowing into the systemic circulation. Two patients developed signs of a reperfusion syndrome within the first hour after reperfusion (decrease in peripheral systemic resistance).

Adult↗
PubMed1996

[Neuromuscular blockade after atracurium and alcuronium with propofol and thiopental].

UNLABELLED: Does propofol or thiopentone enhance the effect of nondepolarizing muscle relaxants? We evaluated the effects of propofol and thiopentone on the pharmacodynamics of atracurium and alcuronium in 43 surgical patients (ASA I and II) under general anaesthesia. METHODS: The patients were randomized into five groups, A-E. Anaesthesia was induced in all patients with fentanyl 4 micrograms/kg i.v. Patients in groups A and C patients received thiopentone 7 mg/kg i.v., and relaxation was achieved with alcuronium 0.25 mg/kg (group A) and atracurium 0.5 mg/kg (group C). Electromyography (train of four, TOF) was used to determine the time of onset of relaxation (AZ) and the maximum degree of blockade (T%). The recovery times to 25%, 50% and 75% of baseline muscle strength were recorded. Additionally, the TOF ratio T4:T1 was calculated, indicating the probable end of relaxation at a ratio of 0.7. At the beginning of the recovery phase (T1 = 15%) propofol 1% 3 mg/kg was given, and the effect on the TOF was measured. Patients in groups B and D patients received total intravenous anaesthesia (TIVA) with propofol 1% 6-12 mg/kg per hour continuously after induction with 3 mg/kg. The action profile of alcuronium 0.25 mg/kg (group B) and atracurium 0.5 mg/kg (group D) were recorded. Group E patients received thiopentone (10 mg/kg per hour) under the use of atracurium 0.5 mg/kg. Ventilation was performed with 30%/70% oxygen and N2O. The results were analyzed for significance using the Mann-Whitney U-test (P = 0.019). RESULTS: A slight difference in AZ was noted for alcuronium under the use of TIVA between propofol and thiopentone: 13 min and 5 min, respectively. Otherwise, the pharmacodynamics (T% and recovery of neuromuscular function) of the two relaxants exhibited no major differences related to thiopentone, propofol or their combination. The TOF was not influenced under additional propofol application. Noteworthy were the wide distribution of the time course of action (up to 3 h) and the magnitude of T% depression under alcuronium. CONCLUSION: Propofol and thiopentone have no potentiating influence on the time course of action and the magnitude of relaxation with alcuronium and atracurium. Pharmacodynamics of nondepolarizing muscle relaxants do not seem to be influenced by these two hypnotics.

Adjuvants, Anesthesia↗
PubMed1996

[Ventilation via a transnasally placed pharyngeal tube. Comparison with mask ventilation].

OBJECTIVE: The present prospective study was designed to investigate the respiratory function during ventilation via a tube inserted through the nose into the pharynx. Results were compared with respiratory parameters measured during conventional mask ventilation in the same patients. METHODS: 20 ASA physical status I-II patients were studied after approval by the local Ethics Committee. Anaesthesia was induced with alfentanil 15 micrograms/kg and propofol 2.5-3.0 mg/kg and maintained with propofol, 12-15 mg/kg/h. Patients were ventilated via a facemask with oxygen and a tidal volume of approximately 8ml/kg (measurement A). After insertion of a tube (I.D. 7.0-7.5 mm) through the nostril into the pharynx ventilation was repeated in the same manner (measurement B). To secure airway seal a second person closed the patient's mouth and exerted cricoid pressure. Following neuromuscular blockade with suxamethonium (1.5 mg/kg) respiratory parameters were measured again (C). Measurements included pulse oximetry and side stream spirometry with continuous collection of the following data: airway pressure, inspired and expired tidal volume, dynamic compliance, expired volume in one second, inspiratory and expiratory oxygen and carbon dioxide concentration. Pressure-volume and flow-volume loops were displayed continuously. RESULTS: Ventilation via facial mask or via pharyngeal tube with and without relaxation showed normal endtidal FECO2. The mean values were 4.5 +/- 0.7%, 4.8 +/- 0.4% and 4.6 +/- 0.7%, respectively. Mean oxygen saturation exceeded 98% in each period. Leakage during mask ventilation was 59.3 +/- 65.5 mL and decreased to 40.5 +/- 62.1 mL with the pharyngeal tube, whereas relaxation resulted in a significant increase to 92.3 75.0 mL. Compliance (Cdyn) and expired volume in one second (V 1.0) did not change significantly during the entire period of measurement. CONCLUSION: The use of a pharyngeally placed tube proved adequate compared to conventional mask ventilation in 20 patients without underlying airway disease.

Adolescent↗
PubMed1996

Cardiopulmonary effects of lying position in anesthetized and mechanically ventilated dogs.

Cardiopulmonary effects of right-lateral and supine (on back) lying position were investigated in 8 anesthetized and mechanically ventilated dogs. Complete hemodynamic and respiratory monitoring were obtained. Heart rate was significantly higher, blood pressure, systemic vascular resistance and left and right ventricular stroke work were significantly lower in supine in comparison to right-lateral position. Arterial and mixed-venous oxygen tensions and mixed-venous oxygen saturation were significantly higher in right-lateral position. Compliance was significantly higher and peak ventilation pressure significantly lower in supine position. Arterio-to-mixed-venous-oxygen content difference, oxygen consumption and utilization were significantly higher and respiratory quotient was significantly lower in supine position in comparison to right-lateral position. All other obtained parameters were not be influenced by posture.

Anesthesia, Intravenous↗
PubMed1996

[Intraoperative EEG monitoring in hemihepatectomies].

End-stage liver diseases are correlated with specific EEG changes. In chronic liver diseases normal EEG excludes hepatic encephalopathy. To date, it is not known at what time EEG changes appear in liver dysfunction and whether they are to be seen during the unhepatic phase in hemihepatectomies. To clarify this, we analyzed EEGs in 10 patients during hemihepatectomies with the CATEEM system. During the hemihepatectomies an occlusion of the liver hilus for 20-38 minutes (on average 28 minutes) was necessary. During and after the occlusion we found no changes in EEG. We conclude that brief failure of liver function under general anaesthesia is tolerated without danger to the central nervous system.

Adult↗
PubMed1995

[Fournier's gangrene. Experiences and changes in the disease picture since its initial description].

Fournier's disease mostly occurs in immunosuppressed men in the 5th to 7th decade of life. Bacteria from the urogenital or colorectal tract lead to a rapid spreading soft tissue infection. Painful scrotal or perineal swelling and a black spot as a sign of beginning necrosis are guiding symptoms. Involved bacteria are grampositive cocci, enterobacteriaceae and anaerobes. Main principles of therapy are immediate radical debridement and broad spectrum antibiotics. Sepsis renders the prognosis more infaust.

Aged↗
PubMed1995

[Is preventive perioperative dopamine administration of value?].

Dopamine interacts in a dose dependent manner with three types of receptors: the alpha- and beta-adrenoceptors and specific dopaminergic receptors. Hence dopamine can exert direct and indirect renal effects. Stimulation of myocardial beta 1-receptors causes an increase in cardiac output and a subsequent augmentation of renal blood flow. However, a major role of selective renal vasodilation in response to dopamine has been brought into question by recent studies. In addition, dopamine has been shown to decrease tubular transport of sodium and to produce sodium diuresis. This natriuresis may induce volume depletion with further deterioration of renal function. Expectations that low-dose dopamine could have a renal-sparing potential did not prove true. Prophylactic infusion of low-dose dopamine in patients undergoing aortic surgery, orthotopic liver grafting or renal transplantation failed to show a renal protective effect or an improved clinical outcome. The routine use of "renal-dose" dopamine therefore cannot be recommended. More attention must be paid to prevent or abolish prerenal causes of renal impairment. Basic measures as volume expansion, care of cardiocirculatory status and close monitoring of renal function are of special importance.

Aortic Diseases↗
PubMed1994

[Combined lung and liver transplantation. Anesthesiologic management].

A 53-year-old man with alpha-1-antitrypsin deficiency had an 8-year history of progressive dyspnoea and two episodes of bleeding oesophageal varices with liver decompensation. After the diagnosis of terminal pulmonary emphysema (Fig. 1) and liver cirrhosis with progressive liver failure was made, he was accepted for combined lung and liver transplantation. METHODS. Anaesthesia was induced with thiopentone and fentanyl and maintained with fentanyl, midazolam, and isoflurane. After relaxation with succinylcholine, the patient's trachea was intubated with a left endobronchial double-lumen tube. Haemodynamic monitoring included arterial, central-venous, pulmonary-artery, and capillary-wedge pressures and cardiac output measurement. Ventilatory monitoring consisted of pulse oximetry, side-stream spirometry, and continuous measurement of arterial and mixed-venous blood oxygen saturation with fibreoptic catheters. A left single-lung transplantation was performed under one-lung ventilation without cardiopulmonary bypass. Prostacyclin was infused to reduce pulmonary vascular resistance. The transplant was ventilated separately with 50% oxygen and positive end-expiratory pressure of 8-10 cm H2O, and then liver transplantation was carried out. The institution of veno-venous bypass during the anhepatic phase failed because of portal-vein and axillary-vein thrombi. RESULTS. Total operation time was 6 h 30 min. Clamping of the left pulmonary artery lasted 45 min and the duration of the anhepatic phase was 92 min. Ventilation and oxygenation during lung transplantation caused no problems (Table 1). Clamping of the left pulmonary artery caused a slight increase in pulmonary vascular resistance (104 to 124 dyn.s.cm-5) and mean pulmonary artery pressure (25 to 27 mm Hg) without a decrease in cardiac index (Table 2). During the anhepatic phase with exclusion of the portal vein and inferior vena cava, a marked decrease in cardiac index (-27.2%) was seen (Table 4). The operation required substitution with 10 units packed red blood cells, 12 units fresh frozen plasma, and 5 platelet concentrates. The post-operative course showed normal liver graft function (Table 5). Acute pulmonary rejection on the 7th day was treated successfully with methylprednisolone. The patient's trachea has extubated 10 days after transplantation and he was discharged from the intensive care unit 2 weeks later. CONCLUSION. The management of this combined lung and liver transplantation was performed according to the experience with isolated lung and liver transplants in our hospital. Aggressive haemodynamic and ventilatory monitoring, including systemic and pulmonary arterial fibreoptic catheters, seems of particular importance in such high-risk procedures.

Anesthesia↗
PubMed1994

Blood volume determination with sodium fluorescein and radioactive chromium--a clinical comparison of methods.

OBJECTIVE: There exists no method so far for the determination of circulating blood volume as an important parameter of circulatory function widely usable under clinical conditions. Therefore, the present study was designed to investigate whether identical distribution spaces could be measured by two methods for blood volume determination using sodium fluorescein (SoF) and radioactively labelled red blood cells (51Cr*). DESIGN: Comparative study. SETTING: Operating theatre, recovery room, or intensive care unit of a university hospital. PATIENTS: 35 patients undergoing abdominal, urological or vascular surgery. INTERVENTIONS: Simultaneous determinations of blood volume using SoF and 51Cr* in the intra- and postoperative period. RESULTS: There were no significant differences between the calculated means of blood volume (4,445 vs. 4,407 ml), red cell volume (1,554 vs. 1,540 ml), and plasma volume (2,891 vs. 2,807 ml) for 51Cr*-vs. SoF-stained red blood cells. The coefficient of correlation between the two methods was r = 0.95. The mean percentage error was -0.6% between the two methods, the precision 5.6%. CONCLUSIONS: SoF-stained erythrocytes allow a determination of the same distribution space as the well-established radioactive method using 51Cr*. Therefore, SoF-staining may replace 51Cr* labelling of red blood cells for the determination of blood volume in patients.

Adult↗
PubMed1993

Calcium carbonate (CaCO3): an efficient and safe phosphate binder in haemodialysis patients? A 3-year study.

In an uncontrolled study, 22 dialysis patients (46 +/- 14 years, duration of dialysis 20 +/- 11 months) were treated with CaCO3 over a period of up to 3 years to lower their serum phosphate. The use of 4.5-9 g CaCO3 daily over a period of 9 months led to a reduction of mean serum phosphate from 2.51 to 1.51 mmol/l in 77% of patients, with a simultaneous increase in mean calcium concentration from 2.23 to 2.47 mmol/l, and an improved control of secondary hyperparathyroidism by reduction in mPTH from 1552 to 1032 pg/ml and in APH activity from 6.25 to 4.55 mumol/s/l. In long-term CaCO3 treatment of up to 3 years, however, a constant effective phosphate reduction could not be achieved. There was a progression (77%) of pre-existing microcalcification and a new appearance (42%) of microcalcification in vessels and soft-tissue areas of the hand. The percentage of patients with soft-tissue calcification increased from 43 to 67% during a treatment period of 3 years. We conclude that CaCO3 alone is not suitable on a long-term basis for phosphate reduction in dialysis patients.

Adult↗
PubMed1992

[2-Amino-oxazoles as potential H-bonding agents in virostatic research. 4. Pharmacokinetics and pharmacologic-toxicologic profile of 2-guanidino-4,5-dipropyloxazole hydrochloride].

Out of the group of 2-amino-oxazoles 1 was found to be the most potent antiviral compound. Following p.o. or s.c. administration to rats, the 14C-labeled 1 was quickly and completely absorbed. The TRA was eliminated mainly via the kidneys and the liver with half-lives between 32 and 42 h. The acute pharmacodynamic effects of 1 were decrease of blood pressure, bradycardia, and inhibition of both gastric emptying and acid secretion. On smooth muscles spasmolytic and alpha-anti-adrenergic actions were predominant. After single administration the following MTD's were determined: 30 (mouse), 20 (rat), 10 mg/kg i.v. (pig), and 500 (mouse, rat), greater than 100 mg/kg p.o. (pig), respectively. In a subchronic toxicity study in rats, oral doses of 1 between 15 and 240 mg/kg given daily for 4 weeks were tolerated without any severe alterations related to the drug.

Administration, Oral↗