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F Feyerherd

Publications and source records attributed to F Feyerherd.

8 recordsLinked to original sources
PubMed1998

[Application of the laryngeal mask for elective percutaneous dilatation tracheotomy].

Percutaneous dilatational tracheostomy is an increasingly accepted procedure for bed-side tracheostomy. The exact positioning of the endotracheal tube, the localization of the point for puncturing the trachea and damage to the endotracheal tube and the cuff as well as to the bronchoscope due to the puncturing process are technical problems which can endanger the course of the operation. In a prospective randomized study, we examined whether use of the laryngeal mask airway (LMA) is a real alternative to the endotracheal tube during tracheostomy. Of 48 consecutive patients only 43 fulfilled all criteria for this study: PaO2 > 100 mmHg, PaCO2 < 45 mmHg (in patients with head injury < 35 mmHg) under intermittent positive pressure ventilation (IPPV) with a mean ventilation pressure of < 25 mmHg and an FiO2 of 1.0. Patients with intestinal obstruction, hemorrhages of the mouth and nose and unfavourable anatomic conditions were not included in this study. Three more patients had to be excluded from the study because of technical problems. In 21 patients tracheostomy was performed using an endotracheal tube (ET group) and in 19 patients using a LMA (LM group). After positioning of the endotracheal tube or the LMA, tracheostomy was performed in the usual way. Arterial blood gases (PaO2 and PaCO2) were investigated before positioning of the endotracheal tube or the LMA, five minutes after this procedure and five minutes after the end of tracheostomy. Mean arterial pressure (MAP), heart frequency (HF) and peripheral oxygen saturation (SpO2), endexpiratory CO2 partial pressure (PetCO2) and minute ventilation volume (MVV) were registered every 60 seconds. The ET group and LM group did not differ regarding basic diseases, age and severity of illness. Before the beginning of tracheostomy, there were no differences in MAP, HF, SpO2, PetCO2 and PaCO2 between the two groups. Before tracheostomy, only PaO2 was significantly higher in the LM group than in the ET group. Immediately before the insertion of the tracheal cannula and five minutes after the end of tracheostomy, there were no differences in the measured parameters of the two groups. An increase in PetCO2 and a decrease in minute ventilation volume were observed in both groups. Regarding technical complications, the LMA is a safe alternative to the endotracheal tube. The choice of method should depend on the basic disease and the patient's ventilation requirements at the time of tracheostomy, while there is still a call for safe instruments guaranteeing sufficient sealing of the respiratory tract during the dilatational tracheostomy and simultaneous avoidance of technical problems during puncturing of the trachea and widening of the point of puncturing.

Adult↗
PubMed1994

[Local oxygen supply to the cerebral cortex during thiopental and propofol anesthesia. First results].

Because the brain is highly vulnerable to damage from even a brief imbalance of oxygen delivery and demand, intraoperative disturbances of local oxygen supply must be avoided. Until now, there has been no method allowing fast and reliable intraoperative measurement of the local oxygen supply in the human brain. Intraoperative investigations were therefore performed using the Erlangen micro-lightguide spectrophotometer. METHODS. Intraoperative investigations of local intracapillary haemoglobin saturation (SO2) were performed during neurosurgical interventions using the Erlangen microlightguide spectrophotometer (EM-PHO). Measurements were performed in eight patients (age 31-67 years) during neurosurgical interventions. Three received thiopentone anaesthesia, and three received propofol. In two patients thiopentone anaesthesia was later changed to propofol. The EMPHO enables rapid, non-invasive measurement of local intracapillary SO2. White light from a Xenon-arc lamp is transmitted by a 250-microns micro-lightguide to the tissue. The remitted (reflected) light is led by 6 micro-lightguides surrounding the illuminating one to a rotating band-pass interference filter disk. Light in the range of 502 to 630 nm is detected with a photomultiplier. In this range haemoglobin shows an SO2-dependent spectrum, which is then analysed. Because the measurements are performed with micro-lightguides, high spatial resolution is attained. Representative measurements can be performed in a very short period of time (approx. 60 s); thus, the EM-PHO enables rapid monitoring of local SO2 in the brain. RESULTS. The effect of propofol and thiopentone anaesthesia on the distribution of local intracapillary haemoglobin saturation was investigated during neurosurgical interventions. The arterial PCO2 was similar in both groups (31 +/- 0.7 and 31 +/- 0.5 mmHg, respectively). There were also no differences in arterial blood pressure. The FiO2 was 0.28 +/- 0.04 in the thiopentone group and 0.30 +/- 0.1 in the propofol group. In all patients receiving propofol anaesthesia higher local SO2 values were found, even if the patients first received thiopentone (values in parenthesis). The mean local SO2 amounted to 65.4% (57.3%) in the propofol group and 38.8% (45.2%) in the thiopentone group. The number of values below 25% SO2 was 5.6% (5.8%) in the propofol group and 18.7% (19.1%) in the thiopentone group.

Adult↗
PubMed1994

[Anesthesiological risks in neurologic diseases].

For an exact evaluation of the risks of operations it is necessary to assess both co-existing and concomitant diseases before the performance of anaesthesia. The relatively low incidence of neurological and muscular diseases (0.02 to 0.7/1,000) and the low probability of an operation of a patient suffering from these diseases lead to higher anaesthesiological risks during the operation and the perioperative period. The anaesthetist is usually not always aware of all the special pathophysiological problems which have to be taken into consideration when these patients have to be anaesthetized. In order to reduce the risk of anaesthesia of these patients, we discuss the most important of these uncommon neurological diseases regarding their special anaesthesiological management.

Anesthesia, General↗
PubMed1993

[Selective gut decontamination in ventilated intensive therapy patients].

Treatment of long-term artificially ventilated patients is often complicated by nosocomial infections. The infection that occurs with the highest frequency during intensive care treatment is pneumonia (22-63%). Ninety per cent of nosocomial infections of intensive care patients are endogenous infections caused by mainly gram-negative aerobic microorganisms that have colonized in the gastrointestinal tract. Selective decontamination of the intestine provides a method that prevents nosocomial infections. In a prospective study 13 patients whose oropharynx and gastrointestinal tract had been decontaminated (SDD) were compared to 17 patients in a control group. In a third group twelve patients were decontaminated in the gastrointestinal tract (SGD) only, and in a fourth group 16 patients were decontaminated in the oropharynx (SMD) only. Trachea, oropharynx and faeces of the patients belonging to the control group (KG) were colonized to almost 100% with gram-negative bacteria. Only 10% of the patients of the SDD and SMD groups showed gram-negative bacteria located in the trachea and oropharynx after one week of decontamination. No gram-negative aerobic bacteria were present after seven days in the faeces of the patients of the SDD and SGD groups. There was no difference with regard to the trachea and oropharynx between the control group and the SGD group. The gram-negative aerobic intestinal flora was not affected by the selective mouth decontamination. The average rate of pneumonia occurrence within the 15-day observation period was 28.2% for the control group, 14% for the SGD group, and 9.6% for the SDD group, and 4.1% for the SMD group. Decontamination of the oropharynx of patients is essential in order to successfully prevent pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[The HELLP syndrome--3 case reports with clinically different course].

Three case reports of patients with HELLP-syndrome show how different the clinical courses in HELLP-syndrome may be. A maternal case of death after eclampsia and HELLP-syndrome explains that early diagnosis and immediate therapy are important for success in the treatment of HELLP-syndrome. After delivery--at present the only efficient causal therapy (we recommend a quick cesarean section after making the diagnosis)--an increase of the number of thrombocytes and a normalization of the liver enzymes can be observed within a few days. An intensive co-operation of obstetricians, anesthetists, and pediatricians in the treatment of patients with HELLP-syndrome is necessary.

Adult↗
PubMed1987

[Behavior of thrombocytes in low-dose heparin therapy].

In a little prospective study it could be shown that a series of 10-51 low dose heparin injections may be followed by slight or unspecific thrombocyte diminutions without specific heparin antibodies being available. Depending on stress and trauma potential complement activations caused by heparin histon complexes may result in insignificant thrombocyte diminutions by liberating those factors activating platelets from granulocytes. These are not bound to interrupt heparin therapy or heparin prophylaxis.

Blood Platelets↗