In 13 patients scheduled for intradiscal therapy with chymopapain we performed continuous lumbar epidural anaesthesia as a method of intra- and postoperative pain relief. In all patients epidural anaesthesia provided a sufficient analgesia by the use of bupivacaine 0.75% intraoperatively. In contrast to chemonucleolysis under general anaesthesia only half of the patients needed postoperative pain therapy, which was achieved by the epidural injection of bupivacaine 0.25%.

Adult↗

PubMedDate not supplied

[Metabolic changes caused by an extremities tourniquet and its modification by anesthesia procedures].

In 3 groups of 15 patients, respectively, we studied metabolic changes following tourniquet-release after operations of lower extremity. The influence of different anesthetic methods was evaluated by blood-gas-analyses up to 30 minutes after blood-circulation of the lower limb had been reinstalled. Our results demonstrate, that the patients under regional anesthesia with spontaneous respiration (group 1) could preserve their metabolic equilibrium with minor changes within the physiologic range. The intubated patients with controlled respiration (group 2) revealed a marked metabolic acidosis after tourniquet-release with insufficient respiratory compensation. Initial values were not reached within 30 minutes. The patients of group 3 (controlled respiration with a 25% increase of the normal minute volume for a period of 5 minutes after release of the tourniquet) had a less severe acidosis than those of group 2. The beneficial influence of spontaneous respiration in compensating metabolic acidosis--even in aged patients--following an ischemic tourniquet has been demonstrated by this investigation. Short-term hyperventilation seems to be the therapeutic tool in patients with controlled respiration to compensate for metabolic acidosis up to a certain extent.

Acid-Base Equilibrium↗

PubMedDate not supplied

[Incidence of air embolism in implantation of hip prostheses].

The prosthetic supply of the hip-joint may be accompanied by the problem of venous air embolism. By including 53 orthopaedic patients having undergone total hip replacement, the influence of bone-cement as well as of the different anaesthetic techniques on the frequency of embolic phenomenons was investigated. Embolism was determined as an abrupt decrease (greater than 5 mmHg) in the end-tidal pCO2. Venous embolism often occurred with cemented endoprostheses in contrast to non-cement implantations. Patients with general anaesthesia presented more often with venous air embolism than patients with epidural anaesthesia. This might be explained by an expanding effect of nitrous oxide on air bubbles entering the vascular bed under the implantation of the shaft-prostheses. Our data stress the importance of continuous monitoring of end-tidal pCO2 for early discovery of lung embolism.

Aged↗

PubMedDate not supplied

Function of the adrenal cortex during therapy with fluconazole in intensive care patients.

An impairment of cortisol synthesis can be assumed for the new antimycotic fluconazole based on its chemical structure (triazole derivative) and mechanism of action (inhibition of ergosterol synthesis). In healthy volunteers, however, no influence on steroid hormone production could be found. The present study was undertaken to clarify whether this is also true for critically ill, long-term patients in an intensive care unit. The basal cortisol and adrenocorticotropic hormone (ACTH) levels were determined by means of radioimmunoassay in 11 patients being treated with antimycotics at fixed times. Antimycotic treatment was carried out using either fluconazole (n = 6) or a combination of amphotericin B and flucytosine (n = 5) for 14 days. Seven days after cessation of the treatment the above-mentioned hormones were again determined. Patients with the same baseline criteria who did not require antimycotic treatment (n = 8) served as controls. During the entire study period adequate cortisol synthesis was found after ACTH stimulation in all three patient groups. They all presented with relatively raised basal cortisol levels (range 16.4-31.0 micrograms dl-1) and an increase in ACTH-stimulated cortisol synthesis from 31% (group ampho B/flucytosine) to 78% (group fluconazole). The basal ACTH values were always within the normal range (9.2-16.4 pg ml-1). Neither the basal ACTH levels nor the basal cortisol levels as well as the cortisol levels determined after the ACTH test showed adrenocortical suppression in the patients of all three groups. Thus, according to the present results clinically relevant impairment of cortisol synthesis after treatment with fluconazole can be excluded.

Adrenal Cortex↗

PubMedDate not supplied

[Reduction of bacterial contamination during mechanical autotransfusion by uv irradiation--initial results].

OBJECTIVE: To investigate the effects of UV-radiation of autologous blood on bacteria and red blood cells when using intraoperative sampling of autologous blood using a cell separator--an established method for reducing the need for donor blood during surgery--which is reported to have a bacterial contamination rate of 5-75%, due mainly to coagulase-negative staphylococci (CNS). METHODS: Cell-separator blood was diluted to a haematocrit level permitting transmission of 1% of the UV-radiation used in this study (lambda 254 nm, coat thickness 1 mm). CNS samples were irradiated for 2, 4, 10, 20 and 30 seconds. Free haemoglobin and methaemoglobin levels were measured, and erythrocytes examined microscopically at the end of the procedure. RESULTS: Blood samples had to be diluted to a haematocrit of 1% to permit transmission of 1% of the UV light. The optimal irradiation duration was 4 seconds, when bacteria were completely eliminated. Longer irradiation durations were associated with increasing levels of free haemoglobin and methaemoglobin, the levels of which at 4 seconds exposure were 12.5 mg/L and 15.5%, respectively. CONCLUSIONS: It is possible to prevent CNS contamination of cell-separator blood by irradiation with UV light. Prior to clinical application, however, the method will need to be modified to minimize side effects and increase its decontamination efficacy.

Blood Transfusion, Autologous↗

PubMedDate not supplied

Anesthesia in pediatric heart transplantation.

Heart transplantation is a widely accepted therapy for end-stage myocardial failure in adults. However, few centers have experience in the treatment of newborns and children. The management of these children from the anesthesiologic viewpoint is demonstrated in our first 10 patients. Ages ranged from 5 days to 5 years; weights ranged from 2900 gm to 16 kg. The children suffered from hypoplastic left heart syndrome (n = 5) or cardiomyopathy (n = 5). Eight patients had to receive catecholamines (dobutamine) before surgery. In neonates cardiopulmonary bypass (CPB) with hypothermic cardiac arrest at 18 degrees C was used; in the older children continuous CPB at 24 degrees to 28 degrees C was performed. Inotropic support during and after weaning from CPB was necessary in all patients who received dobutamine (range, 2 to 10 micrograms/kg/min), epinephrine (range, 0.03 to 1.0 microgram/kg/min), or both. The phosphodiesterase inhibitor enoximone (1.0 mg/kg) was administered to five patients. Prostaglandin E1 was given to four patients, and it was necessary to give additional tolazoline to two patients. Heart transplantation is a challenge for anesthesiologists during the prebypass period as well as during the weaning and early postbypass periods. More experience is necessary to optimize the anesthetic management of these children.

Alprostadil↗

PubMedDate not supplied

Enhancement of myocardial energy potentials in man by glucose-insulin treatment before and after ischaemic heart arrest.

Thirty-six patients undergoing aortic valve replacement were investigated to ascertain whether the addition of glucose-insulin before and after ischaemic heart arrest could aid to the functional recovery of hearts following global ischaemia. One group of patients (n = 14) received glucose plus insulin from the onset of anaesthesia until crossclamping of the aorta (1 g + 1.5 U/kg bw X h). A second dose (0.5 g + 1.0 U/kg bw) was given at the end of ischaemia. 22 patients, serving as control received glucose in the same manner but without insulin. Needle biopsies from the left ventricular apex region were obtained: before starting cardiopulmonary bypass; at the end of ischaemia; and after 10 minutes of reperfusion and analyzed for its content of ATP, CP ADP and lactate. In both groups ATP and CP were significantly decreased after ischaemia and increased after reperfusion. ADP and lactate levels were elevated after ischaemia and decreased after reperfusion in the insulin-group but not in the control-group. During the total investigation period ATP- and CP-concentrations in the insulin-group were higher compared to the control-group, whereas ADP and lactate of the control-group were above the insulin-group.

Adenosine Diphosphate↗

PubMedDate not supplied

A comparison of the cardiovascular effects of enflurane, halothane, methoxyflurane and fluroxene during open cardiac surgery.

During open heart surgery hemodynamic changes due to 1.5% enflurane, 0.75% halothane, 0.18% methoxyflurane and 3.4% fluroxene have been compared. The following parameters have been measured: arterial pressure, heart rate, cardiac output, right and left atrial pressure, left ventricular pressure and dp/dt. The strongest effects were found with enflurane and halothane. Marked reduction in cardiac index, stroke index, left ventricular dp/dt as well as reduction of peripheral resistance caused severe systemic hypotension. Because of its slow uptake methoxyflurane was followed by small hemodynamic changes in this study. The rapid acting fluroxene had caused only minor reductions of cardiac output, stroke volume and dp/dt. There was no decrease in peripheral resistance.

Blood Pressure↗