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Biomedical subjects

F J Dannemiller

Publications and source records attributed to F J Dannemiller.

13 recordsLinked to original sources
PubMed1979

A guideline for anticipated blood usage during elective surgical procedures.

A realistic guideline for transfusion therapy was prepared, with the cooperation of the departments of anesthesiology and surgery, in order to reduce excessive crossmatching. The guideline recommends an ABO-Rh type and an antibody screen, instead of the ""routine'' two-unit crossmatch, for elective surgical procedures where blood is seldom used. For those operations normally necessitating hemotherapy, the number of units suggested for the preoperative crossmatch was determined by examination of the average number of units transfused in the past for that particular procedure. The guideline provides the anesthesiologic and surgical staff with the knowledge of how much blood was usually used during a particular elective surgical procedure and therefore how much blood should be preoperatively crossmatched for that procedure. Implementation of this guideline allows the blood bank to distribute its limited blood resources more efficiently and also decreases patient and laboratory costs.

ABO Blood-Group System↗
PubMed1976

Acute respiratory failure and intravascular coagulation.

The possible association between acute respiratory failure and disseminated intravascular coagulation was examined in eight patients with severe acute respiratory failure--a condition characterized by tachypnea, right to left intrapulmonary shunting of blood greater than 30 per cent of cardiac output, increased pulmonary artery pressure with low or normal pulmonary artery wedge pressure and roentgenologic interstitial pulmonary edema. Treatment consisted of mechanical ventilation with positive end expiratory pressure sufficient to minimize intrapulmonary shunting. There was no abnormality in platelet concentration fibrin split product concentration, fibrinogen concentration, prothrombin time or activated partial thromboplastin time during the period of most severe respiratory failure in any patient. However, mean platelet concentration fell to 90,000+/-9,000 per cubic millimeter, less than 0.001, and mean fibrin split product levels rose to 60+/-10 micrograms per milliliter, p less than 0.05, the fourth day after the onset of acute respiratory failure. No significant change occurred in other coagulation parameters. Disseminated intravascular coagulation developed in none of the patients nor was there any correlation between coagulation abnormalities and severity of acute respiratory failure that would suggest a cause and effect relationship.

Acute Disease↗
PubMed1975

High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency.

Twenty-eight patients developed severe, progressive acute respiratory insufficiency despite aggressive application of conventional respiratory therapy. Application of increased PEEP (18 torr or greater) resulted in a significant decrease in QA/QT. Selection of the optimal levle of PEEP for each patient required serial determinations of QA/QT and measurement of cardiovascular response. The overall survival rate was 61 percent. Acute respiratory insufficiency was a proximate cause of death in only one patient. Four of the patients (14 percent) developed a pneumothorax following institution of high PEEP therapy. Cardiac output was not affected adversely at any level of PEEP up to 32 torr (44 cm H2O). We conclude that high levels of PEEP can be therapeutic for patients with refractory respiratory failure when combined with intermittent mandatory ventilation and careful cardiovascular monitoring. As with any therapy, the optimum dose should be tailored to each patient according to his needs and response.

Acute Disease↗
PubMedDate not supplied

"Hyper-" end-expiratory pressure in the treatment of adult respiratory insufficiency: a case report.

Postiive end-expiratory pressure (PEEP), in combination with mechanical ventilation, is efficacious in the treatment of some forms of adult respiratory insufficiency. PEEP in excess of 10 to 15 torr usually is not recommended; however, higher levels of PEEP may be required to reverse the pulmonary venous admixture. The efficacy of optimizing cardiopulmonary function with varying levels of PEEP is described.

Adult↗
PubMedDate not supplied

Change in pulmonary venous admixture with varying inspired oxygen.

Pulmonary venous admixture (Qsp/Qt) was analyzed as a function of fractional concentration of inspired O2 (FIO2) in 30 patients who required postoperative mechanical ventilation. Pulmonary and radial artery blood-gas tensions and pH were measured and Qsp/Qt was calculated with FIO2 ranging from 0.21 to 1. In all patients, Qsp/Qt decreased when FIO2 was increased from 0.21 to 0.4 and then stabilized to an FIO2 of approximately 0.6. As the FIO2 was increased to 1, Qsp/Qt increased. Since the inhalation of gas mixture with FIO2 greater than or equal to 0.6 increased right-to-left intrapulmonary shunting of blood, we recommend respiratory function be evaluated during inhalation of a clinically useful concentration of O2 rather than at an FIO2 of 1.

Humans↗
PubMedDate not supplied

Cardiovascular responses to clamping of the aorta during epidural and general anesthesia.

The cardiovascular responses of aortic cross-clamping and declamping with normal and high ventricular filling pressures were compared during epidural and nitrous oxide-morphine anesthesia in 32 male patients undergoing reconstructive aortic surgery. The patients were divided into four groups. Groups I and II had lumbar epidural blocks with bupivacaine and received nitrous oxide in oxygen to breathe; groups III and IV were anesthetized with morphine (2 mg/kg) and nitrous oxide. During aortic occlusion groups I and III received Ringer's lactate at a rate which maintained mean pulmonary capillary wedge pressure (PCWP) 3 to 4 torr above pre-anesthetic values whereas groups II and IV were given Ringer's lactate rates which kept PCWP similar to pre-anesthetic values. Prior to cross-clamping mean arterial blood pressure and systemic vascular resistance were lower in groups I and II than in groups III and IV but cardiac output, PCWP, and pulmonary vascular resistance were similar in the four gropus. Cross-clamping of the aorta produced no significant change in any cardiovascular variable measured in any group. Declamping did not significantly alter any variable in groups I and III but produced moderate hypotension in group IV and severe hypotension in group II as well as significant decreases in PCWP in both groups. Our data demonstrate that aortic cross-clamping and release result in little change in cardiovascular dynamics in patients anesthetized with epidural or morphine-nitrous oxide and given balanced salt solutions intravenously in amounts adequate to increase left ventricular filling pressures prior to release of the aortic cross-clamp. Our findings also indicate that hypotension can occur in patients in whom left ventricular filling pressures are maintained at normal levels prior to cross-clamp release, especially in patients given epidural anesthesia.

Aged↗