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Biomedical subjects

F W Ahnefeld

Publications and source records attributed to F W Ahnefeld.

At least 127 records · Page 7Linked to original sources
PubMed1983

[Management of anesthesia for the multiply-injured patient with associated craniocerebral injuries].

Adequate anaesthesiological care of polytraumatized patients with associated craniocerebral trauma has the primary objective of preventing secondary cerebral damage. To this end, it is absolutely necessary to be aware of the physiology and pathophysiology of intracranial pressure, cerebral perfusion pressure and cerebral blood flow. The effects on these parameters of physiological feedback parameters, as well as anaesthesiological measures and the drugs used, are discussed.

Anesthesia↗
PubMed1982

The effect of solutions of varying branched-chain concentration on the plasma amino acid pattern and metabolism in intensive care patients.

30 intensive care surgical patients were investigated over a period of five days following trauma or major surgery. They were randomised by card into two groups, Group I received an amino acid solution containing 45 per cent branched-chain amino acids (BCAA), and group II an amino acid solution with a 10 per cent content of BCAAs. After 24 hours of infusion, the total amino acid concentration and branched-chain amino acid concentration in the plasma of Group I patients already clearly exceeded the normal range, and continued to increase during the period of study. In Group II these parameters rapidly returned to normal where they remained. Cumulative negative nitrogen balance and nitrogen excretion on each day of investigation were significantly less in Group II. These results indicate that after severe trauma or major surgery amino acid solutions containing high concentrations of BCAAs may be an unphysiological load on the already stressed metabolism, rather than a benefit.

Journal Article↗
PubMed1982

[Effect of solutions with different amounts of branched-chain amino acids on the plasma amino acid pattern and energy metabolism of surgical intensive care patients].

30 intensive care surgical patients were investigated over a period of five days following trauma or major surgery. The patients were randomized into two groups. Both collectives received equal amounts of protein (1.0 g amino acids . kg-1 . d-1) and carbohydrate (6,7 g . kg-1 . d-1). Under this infusion regimen the patients of group I received an amino acid solution containing 45% branched-chain amino acids (BCCA), the patients of group II an amino acid solution with a 10% content of BCAAs. After only 24 hrs of infusion, the total amino acid concentration and branched-chain amino acid concentration in the plasma of patients receiving the solutions containing 45% BCAAs already clearly exceeded reference range, and continued increase during the entire investigation period. In those patients receiving the 10% branched-chain amino acid solution, these parameters rapidly returned to normal and then remained within reference range. Cumulative nitrogen balance and nitrogen balance on each day of investigation were significantly less negative in those patients administered the amino acid solution with small amounts of BCAAs. These results seem to indicate that after severe trauma or major surgery amino acid solutions containing high concentrations of BCAAs may be an unphysiological load on the already stressed metabolism, rather than a benefit

Adult↗
PubMed1981

[Enteral feeding. New technics and feeding mixtures].

We tried to show, that feeding via intrajejunal tube with a chemically defined diet (CDD) is a procedure possible done in the early postoperative situation beginning with the 1st postoperative day. We investigated 20 patients after cholecystectomy - randomized into two groups (group I: CDD, group II: control; water - electrolyte - substitution via peripheral veins). It was proven, that the CDD - group tolerated the enteral feeding from the beginning very well. The N balance became positive on the 2nd postoperative day. Further investigations and results have to show if this form of tube feeding with a special diet may be a definite alternative to parenteral nutrition in patients after gastrointestinal surgery in the very early postoperative period.

Adult↗
PubMed1981

[Protein and energy metabolism in intensive care patients].

30 intensive-care surgical patients were randomly divided into two groups. Metabolic substrates, nitrogen balance, energy balance, and gaseous exchange were measured. Both groups were investigated under the following conditions: 1. our routinely administered parenteral diet (1.5 g amino acid . kg-1 . d-1 and 7.6 g carbohydrate kg . d-1) 2. an infusion regimen containing an increased amount of carbohydrates, clearly exceeding energy expenditure (1.5 g amino acids . kg-1 . d-1 and 12 g carbohydrate . kg-1 . d-1) and under a two-fold aminod-acid intake (3.0 g . kg-1 . d-1 and 7.6 g carbohydrates . kg-1 . d-1). The energy expenditure of the patients in the two investigated groups averages 3000 kcal . d-1. We can cover this energy expenditure with an increased carbohydrate intake of 12 g . kg-1 . d-1. However, the data observed from the gas exchange measurements--the RQ remained still about 0.9--and urea-nitrogen excretion, suggest that even an excessive administration of carbohydrate does not totally suppress the participation of endogenous fat and protein in the oxidative energy-production process. By administering 3.0 g amino acids . kg-1 . d-1 nitrogen balance can be achieved, but leads to further elevation of BUN levels; while nitrogen excretion is not markedly increased when compared to the patients receiving 1.5 g amino acids . kg-1 . d-1. These results seem to indicate that nearly all of the high amounts of caloric substrates and amino acids are used to meet energy expenditure and nitrogen loss of intensive-care patients in the early period after trauma or severe illness, but they also serve as an additional burden for the extremely stressed metabolism in this situation.

Amino Acids↗
PubMed1981

[The recovery room - function and organization (author's transl)].

Postanaesthetic observation and control of the patient, independently of surgery, is an integral part of the anaesthetic course. The anaesthetic procedure is terminated in the recovery room only, where all negative effects of anaesthesia and surgery or their sequels can be properly assessed and eliminated. After restoration of vital functions and protective reflexes only the patient may be transferred to normal wards or intensive care units for further control of his postoperative condition. Following long-term surgery, and in any high-risk case in general, postoperative mechanical ventilation or application of continuous positive airway pressure (CPAP) can reduce the incidence of respiratory complications. The additional and extensive therapeutic and diagnostic tasks to be covered in the recovery room call for special consideratons in equipping and staffing. Adequately trained nurses in sufficient number, respiratory devices covering any mode of ventilation and an emergency laboratory are indispensable prerequisites for proper function. Only then the anaesthesiologist will be able to satisfactorily perform his comprehensive task of providing stable vital functions, preoperatively in establishing the state of operability, intraoperatively by corrective therapy and postoperatively until anaesthetic effects and surgical trauma have subsided.

Humans↗
PubMed1981

[Behavior of free amino acids in plasma and urine of intensive care patients with multiple injuries during the administration of an amino acid solution with 10% branched-chain amino acids].

The study was performed on eleven severely injured ventilated intensive care patients. Plasma and urine concentrations of free amino acids, nitrogen balance and energy expenditure were studied for a period of six days following trauma. Most of the free amino acids in plasma, especially the BCAA's return to reference range within a few days after trauma on administering the infusion solution investigated. An amino acid imbalance in the plasma of severely traumatized patients could be avoided by infusion of an amino acid solution containing only 10% branched-chain amino acids. The amino acids infused are utilized to an extent of more than 90%. However, a still markedly increased negative nitrogen balance, as well as a clearly negative energy balance indicate, that further investigations on nitrogen - and carbohydrate supply are necessary.

Adolescent↗
PubMed1980

[Aspects of primary PEEP ventilation for immediate treatment of emergency patients (author's transl)].

PEEP ventilation is frequently used in intensive care patients: its particular effects in the immediate treatment of emergency patients are discussed. In animal experiments different studies were performed using manually operated resuscitators combined with a newly designed PEEP valve. The most important results in neonatal pigs show that the post partum compliances and the neonatal PO2 values were much better after primary PEEP ventilation than after IPPB or 2-phases unfolding inflation. The worst method of respiratory resuscitation is the use of PNPB. In 2 other groups of animals immediate PEEP ventilation was compared to IPPB, after 25 ml of fresh water/kg BW had been instilled into the animals lungs. The PaO2 and AaDO2 values of those animals, treated immediately with PEEP were much better than the corresponding values of the ZEEP group animals. But, the PEEP-treated animals showed a significant reduction of the cardiac output. The article deals further with the results of different authors, as far as PEEP and lung edema, PEEP and CPR, PEEP and shock are concerned. In our opinion, the present clinical and experimental results lead to the following conclusions: The immediate PEEP ventilation at the scene is indicated 1. in neonatal resuscitation - 2. in near drowning - 3. in lung edema - 4. in cardiopulmonary resuscitation. PEEP ventilation should however not exceed 10 cm H2O.

Animals↗
PubMed1980

[The concentration of plasma amino acids during continuous infusion of Traumafusin into patients].

2 years ago we presented an amino acid solution with a special pattern for parenteral nutrition in the postoperative, posttraumatic period, which was adapted to this situation. The question arose, if this solution would be tolerated in patients with undisturbed metabolism. 10 male volunteers were infused with the amino acid solution (1 g amino acids/kg body weight/day) over a period of 3 days, and the concentration of the amino acids in plasma was measured at different times. It could be shown, that--without some exceptions--the homeostasis of the amino acids was not altered, that means that the proven amino acid solution can be used also in patients, who do not suffer from a post-aggression syndrome.

Adult↗