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Biomedical subjects

F Lackner

Publications and source records attributed to F Lackner.

At least 37 records · Page 2Linked to original sources
PubMed1987

The esophageal tracheal combitube: preliminary results with a new airway for CPR.

We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.

Adult↗
PubMed1987

[The esophageal tracheal Combitube (ETC): animal experiment results with a new emergency tube].

Prompt and effective ventilation, essential for patients with cardiopulmonary arrest, may be provided by a new airway for emergency resuscitation. The "Esophageal Tracheal Combitube (ETC)" offers endotracheal or esophageal obturator ventilation according to choice. Ventilation is therefore always possible after blind intubation. Experimental studies in dogs showed encouraging results during oesophageal placement of the ETC; blood gas analyses and cardiovascular parameters, in particular, were comparable to conventional endotracheal ventilation. Satisfying results were achieved during routine surgical operations in humans. We intend to use the ETC as a device for emergency cardiopulmonary resuscitation in humans. It is especially suitable for medical personnel not trained in endotracheal intubation. The ETC has been conceived to bridge the gap of the prehospital phase.

Animals↗
PubMed1986

[Comparison of fentanyl and tramadol in pain therapy with an on-demand analgesia computer in the early postoperative phase].

17 patients undergoing cholecystectomy in non-opiate general anaesthesia received tramadol (n = 7) or fentanyl (n = 10) for immediate postoperative pain relief using the on-demand analgesia computer (ODAC). Heart rate, blood pressure, and respiratory rate were monitored at half-hourly intervals during the 6-h trial period. Arterial blood was withdrawn at hourly intervals for blood gas analyses and beta-endorphin plasma level assays. Fentanyl and tramadol serum levels were determined prior to each on-demand bolus injection during the first 2 h of the study. At the end of the trial period, the quality of analgesia was assessed retrospectively using a visual analog scale. Mean opiate consumption was 0.53 +/- 0.1 mg for fentanyl and 412 +/- 11.6 mg for tramadol, resulting in an equipotency ratio of about 1:980 (relating to body wt., consumption/h, and pain score). No correlation was found between body wt.-based opiate requirements and pain score. Heart rate increased slightly but significantly under both opiates. Fentanyl produced a significant drop in mean arterial pressure by a maximum of 16%, while tramadol left mean arterial pressure unchanged. Respiratory rate, which was elevated initially, dropped significantly in both groups. Arterial pO2 and pCO2 were within the normal range throughout the observation period, reflecting the absence of respiratory side effects. Opiate blood levels showed major inter- and intraindividual variations (minimal and maximal levels for fentanyl ranged from 0.44-3.44 ng/ml, for tramadol from 272-1,900 ng/ml) and were thus poor predictors of the quality of analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Risk factors for severe bacterial infections after valve replacement and aortocoronary bypass operations: analysis of 246 cases by logistic regression.

Risk factors for severe bacterial infections, that is, deep sternal wound infection, pneumonia, septicemia, and prosthetic valve endocarditis, were evaluated in 246 consecutive patients undergoing valve replacement (N = 84) or aortocoronary bypass operation (N = 162). Multiple logistic regression analysis was applied to determine the ability of putative risk factors to predict infection. The risk factors considered were age, sex, diabetes mellitus, duration of cardiopulmonary bypass (CPB), duration of operation, amount of blood restored on the day of operation, repeat thoracotomy for bleeding, intraaortic balloon pumping, reoperation, emergency operation, and the professional status of the surgeon. Severe infections occurred in similar frequency after valve replacement (8/84; 9.5%) and aortocoronary bypass (11/162; 6.8%). For patients who had a bypass procedure, repeat thoracotomy was the only factor significantly associated with infection (p = 0.0004). However, the classification analysis revealed that this variable alone is too unspecific for a reliable prediction. Univariate analysis indicated that restoration of more than 2,500 ml of blood (p = 0.0001), reoperation (p = 0.0821), duration of operation (p = 0.0061), duration of CPB (p = 0.0318), and intraaortic balloon pumping (p = 0.0281) were associated with infection following valve replacement. A model with three variables emerged from the multiple logistic regression: after correction for blood restoration, reoperation, and duration of CPB, no other variable was of additional predictive value. For patients who underwent valve replacement, the model performed well in predicting complications. The classification analysis revealed a high correspondence between observed and predicted instances of infection: it correctly predicted 75% of the patients with infection and 96% of those without infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Rapid tracheal intubation with vecuronium: the priming principle.

Following the administration of a single 0.1 mg/kg dose of vecuronium bromide, satisfactory conditions for tracheal intubation developed in 156 +/- 12 s (mean +/- SEM), and the clinical duration of the initial dose was 36 +/- 2 min. When the initial dose of vecuronium was administered in two increments, a 0.015 mg/kg "priming" dose, followed 6 min later by a 0.050 mg/kg "intubating" dose, intubation time decreased to 61 +/- 3 s and clinical duration to 21 +/- 1 min. The priming dose that had no unpleasant effect on premedicated, awake patients could be administered 3-4 min before, and the intubating dose 2 to 3 min after induction of anesthesia. With the described technique, comparable intubating conditions could be obtained just as rapidly with vecuronium as with succinylcholine chloride, without subjecting the patients to the side effects of and the complications occasionally encountered with succinylcholine. An added advantage of the use of a priming dose is that it will reveal undiagnosed, pathologic, or idiopathic increase of sensitivity to nondepolarizing muscle relaxants.

Adolescent↗
PubMed1985

[Nifedipine and vecuronium bromide. How does a patient treated with calcium antagonists react to nondepolarizing muscle relaxants? Brief scientific communication].

The muscle-relaxation reactions of Ca-antagonist (nifedipine) pretreated patients and a control group (5 in each group) were observed after administration of vecuronium bromide using the "priming principle." Twitch depression induced by the "priming dose" of vecuronium bromide (20 micrograms/kg body weight and T4/T1 ratio in the Ca-antagonist-treated patients (35 +/- 13% and 0.42 +/- 0.14%, respectively), was significantly different (P less than 0.01) when compared with the control group (1.2 +/- 2.7% and 0.75 +/- 0.15%). Similarly, the onset time to maximum blockade after the intubating dose of vecuronium bromide (60 micrograms/kg body wt.) was significantly shorter in the nifedipine group (40 +/- 21 s) when compared with the controls (100 +/- 17 s). The duration of the effect observed clinically (until 25% recovery) in the nifedipine group 32.9 +/- 7.3 min versus 25 +/- 8.15 min was enhanced; however, the difference between the treated group and the control group was not significant.

Aged↗
PubMed1985

[Does gelatin as a blood substitute selectively depress plasma fibronectin? A clinical randomized study].

In 18 adult patients, in a randomized way, 15 ml/kg of blood were replaced either by gelatin 5.5 pc or serum protein solution. 0,5, 4 and 24 h later there was only a significant difference between the two groups in total protein and serum albumin. The low molecular weight infection related proteins alpha-1-antitrypsin, immunoglobulin G and antithrombin III, as well as the high molecular weight proteins immunoglobulin M, plasma fibronectin and alpha-2-macroglobulin were at no time significantly different between the two groups. It is concluded that gelatin as a plasma substitute does not impair the opsonising effect of plasma fibronectin upon the reticuloendothelial system.

Adult↗
PubMed1985

[Method of determining glomerular filtration rate and extracellular fluid volume in the perioperative phase].

In the course of an investigation concerning the renal response in abdominal surgery, we paid special attention to the precision of determination of the glomerular filtration rate (GFR) and extracellular fluid volume (ECF). The influence of the applied mathematical model on calculation using slope techniques was examined. ECF and GFR were measured by single injection of the radioactive tracer 51Cr-EDTA; plasma samples were taken during the first 4 h postinjection. The results were computed according to the compartmental and noncompartmental model. The correlation between two-compartmental and noncompartmental GFR and ECF values was highly significant. However, values calculated from two-compartmental model were significant lower (p less than 0.01) and differences up to 20% were observed. Calculating ECF by the most widely used approximative method (assuming an early equilibrium between the extra- and intravascular part of ECF) yields incredible high values and correlation to other methods was poor. Based on our data, we conclude that GFR and ECF values obtained by compartmental analysis depend on flow rates between the theoretical compartments. Also the use of two or three exponential components for the plasma curve in the course of noncompartmental analysis (as done by most authors) is not any better than compared conventional compartmental analysis. Noncompartmental analysis should be preferred especially when small changes in ECF and GFR are observed, as it is the more accurate.

Body Fluid Compartments↗
PubMed1985

[Behavior of renal filtration performance in the massive intraoperative administration of crystalloid solutions].

Renal function of 12 adult patients was studied pre- and postoperatively using tracer techniques in a black-box model. Chrom 51 EDTA was employed to determine extracellular fluid volume and glomerular filtration rate, Iodine 125-albumin to measure plasma volume. These patients who received during two 4-h periods pre- and postoperatively 3 ml/kg/h of a salt-sugar solution had a significantly increased extracellular fluid volume postoperatively. Glomerular filtration rate was also increased, plasma volume was significantly reduced and colloidosmotic pressure in spite of attempts to supplement albumin solution intraoperatively was found to be postoperatively reduced. Hemodynamic parameters were virtually unchanged postoperatively with the exception of a small but significant increase of cardiac index. It is concluded, that these patients who received 12 ml/kg/h of crystalloid solutions apart from colloid replacement of measured bloodloss intraoperatively through natural regulation were about to excrete this extra amount of fluid, which had been relocated in the extracellular space. This regime, however, might help to decrease the rate of oliguric perioperative renal function failure, which has a high mortality.

Adult↗
PubMed1984

[Effect of hemodilution with plasma protein solution and hydroxyethyl starch on plasma fibronectin].

In nine adult patients at least 24 hours prior to vascular surgical operations about 25 p.c. of circulating blood volume was replaced by either 6 p.c. hydroxyethyl starch (HES) or 5 p.c. plasmaprotein solution (PPS). Following haemodilution, a proportional significant decrease of plasmafibronectin (PFN) was observed; when PPS was administered, levels were significantly higher than expected due to withdrawal of blood. Serumalbumin was decreased in the same way, however, in patients receiving HES it rose significantly within 24 hours. It is concluded that changes are essentially only dilutional and when haemodilution technique is used, also postoperatively no dramatic reduction of PFN following uncomplicated surgery has to be anticipated.

Adult↗
PubMed1984

[Control of infection in a primarily surgical intensive care unit].

All of one year's 251 patients of a predominantly surgical intensive care unit (i.c.u.) were continuously followed up for infections according to a standard protocol. These protocols were evaluated for 174 patients who stayed at least 48 h at the unit. More than one third (36.7%) were already infected on admission (external origin), 35% contracted infections at the unit, primarily or additionally (internal origin) and 40% remained without an infection. Fifty eight percent of patients already infected on admission were surgical and required intensive care for complications. Among the patients who contracted their infection solely at the unit 61.5% suffered from trauma. Patients having contracted their infections at the i.c.u. stayed significantly longer than those without (additional) infections (13 and 6 days respectively). Mortality was highest (45%) in patients who were already infected on admission and who acquired additional infections during their stay at the i.c.u. Of patients with infections of exclusively external or internal origin 23.5 and 17.9% respectively died whereas among those who remained uninfected this proportion was only 7%. The 75 infections acquired before admission to the i.c.u. included infections of the respiratory tract in 14.4% of all patients, peritonitis with 10.3%, urinary tract in 8.0% and septicemia in 5.2%. Artificial ventilation was employed more often in infected patients (73.8-100%) than in non-infected ones (56.3%). They also carried more intravasal catheters (2.76-3.05 per patient) than the latter group (1.79). Of the 82 infections acquired in the i.c.u. the respiratory tract was affected in 19.5% of all patients and the urinary tract in 13.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Lymphocyte transformation and isovolemic hemodilution with hydroxyethylstarch 450,000.

The effect of hemodilution upon lymphocyte transformation was studied in vivo. 20 p.c. of circulating blood volume was replaced by Hydroxyethylstarch 450,000 6%, (HES 450) and 24 hours later but prior to surgery lymphocyte transformation using PHA was not substantially changed. These findings were in accord with previous in vitro studies. There appeared to be no significant change of the total lymphocyte count, alteration of serum proteins seemed to be proportional presenting a mere dilutional phenomenon. It can thus be concluded that hemodilution does not impair cellular immune defense nor increase the risk for patients prone to sepsis or spread of malignancy.

Blood Cell Count↗
PubMed1983

[Effect of dextran 60,000(D 60) and hydroxyethyl starch 450,000 (HES 450) on lymphocyte transformation].

Lymphocytes of volunteers were recovered, isolated and H3 thymidine incorporation was measured in the presence of D 60 and HES 450 with and without PHA. Without mitogen dextran caused only a marginal increase of incorporation whereas HES brought about no change. When PHA-stimulation was used, both compounds seemed not to influence H3-thymidine incorporation. It is concluded that in vitro even in molar concentrations corresponding to clinical haemodilution these solutions appear not to suppress lymphocytic activity.

Adult↗
PubMed1983

[Arterial baroreflex in intravenous anesthesia and assisted spontaneous respiration].

Effects of a combined intravenous anaesthesia on the baroreceptor control of the circulation were determined in 8 healthy, unpremedicated patients, 18-50 years of age, scheduled for minor surgical procedures. The baroreflex was studied in response to brief hypotension with nitroglycerin (1-10 micrograms/kg i.v.) and quantified using the method described by Smyth, Sleight and Pickering (1969). The latter linearly correlates measurements of systolic blood pressure and the succeeding pulse interval, as obtained from recordings of the electrocardiogram. Responses in the conscious state were compared with those after administering diazepam (0.2 mg/kg i.v.), etomidate (8-20 mg i.v.) and fentanyl (0.015-0.025 mg/kg i.v.) while the patients were breathing a mixture of oxygen and nitrous oxide (1:2) during mechanically assisted ventilation. Anaesthesia led to a decrease in heart rate (17 +/- 3%) together with a slight but significant reduction in mean arterial pressure (15 +/- 4%). The mean slopes and correlation coefficients in the conscious and anaesthetized states were y = 426 + 2.33 X; r = 0.56; p less than 0.05 and y = 663 + 2.16 X; r = 0.49; p less than 0.05, respectively. Thus, no significant difference of the function of the baroreflex was observed in the conscious and anaesthetized patients. It is concluded that in contrast to inhalational anaesthesia the employed combined intravenous anaesthesia with mechanically assisted ventilation does not change this important control mechanism of the circulation in man.

Adolescent↗
PubMed1983

[Endobronchial ventilation in transthoracic endoscopic sympathectomy].

Thoracic endoscopic sympathectomy (TES) is a short surgical procedure used for the treatment of axillary and palmar hyperhydrosis. It involves creation of tension pneumothorax, lateral and head-up position and necessitates minimal lung excursions during breathing, so that a special anaesthetic technique is required. In six otherwise healthy patients an endobronchial double lumen tube was used for one-lung ventilation with intravenous anaesthesia and muscular relaxation, and circulatory response, FE CO2 and blood gases were monitored in order to compare this anaesthetic technique to conventional endotracheal intubation in previous patients. Some difficulties with inserting and securing the double lumen tube were encountered, but were far outweighed by the advantages of stable circulation, physiological blood gas values and easy access to a calm surgical field.

Adult↗
PubMed1983

[Hemoconcentration caused by excessive intraoperative ascites production in ulcer bleeding].

The estimation of the intraoperative fluid requirements can be particularly difficult in patients with compartmental disturbances, e.g. hepatic cirrhosis. The case history of a 41 year old female with a known history of liver cirrhosis is reported who underwent emergency surgery due to upper gastro-intestinal bleeding. In order to maintain hemodynamic stability preoperative blood loss was replaced with fresh blood. During the operation 4 liters of bank and fresh blood with 5 liters of erythrocyte-free fluids were administered. After operation reliable clinical signs of hypovolemia and a marked increase in hematocrit were noted. The severe hemoconcentration was explained by excessive fluid shifts away from the intravascular compartment since a total amount of 10 liters of ascites was collected for the next 24 hours. This overproduction can be related to portal hypertension, hypoalbuminemia and activation of the renin-angiotensin-aldosterone system.

Adult↗
PubMed1982

Effect of dobutamine on cardiac function in man: reciprocal roles of heart rate and ventricular stroke volume.

The cardiovascular effects of dobutamine ( 7 micrograms/kg . min iv) and of additional N-allyl-clonidine (St 567, alinidine; 0.3 mg/kg iv), a compound which selectively inhibits the chronotropic effects of various stimulants, were studied in 9 patients scheduled for major abdominal surgery. Dobutamine increased cardiac index (CI), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), and heart rate, but failed to change the left ventricular stroke volume (LVSV) significantly. Alinidine decreased cardiac rate and increased LVSV index and left ventricular stroke work index (LVSWI), whereas CI, MAP, and MPAP remained virtually unaffected. Similar results were obtained when the combination of dobutamine and alinidine was given to 4 patients in neuroleptanesthesia. Thus, the decrease in preload which is associated wit tachycardia seems to modify the increase in LVSV in response to inotropic stimulation with dobutamine.

Adult↗