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Biomedical subjects

H Böhrer

Publications and source records attributed to H Böhrer.

At least 145 records · Page 8Linked to original sources
PubMed1992

[Surfactant administration in acute respiratory failure].

We report the case of a 21-year-old man who developed adult respiratory distress syndrome (ARDS) after severe lung contusion due to a car accident. At the scene of the accident the patient was awake and oriented, but there were signs of hypoxaemia (SaO2 by pulse oximetry: 86%). The trachea was intubated in the emergency room and, after diagnosis of multiple rib fractures on the right side (the patient nos. 4-11) and emergency treatment, was extubated 16 h later. During spontaneous breathing there was no improvement of pulmonary function, and the patient was transferred to the intensive care unit 5 days later and reintubated because of acute respiratory failure. He then developed the signs of severe ARDS. No improvement occurred during conventional ventilatory treatment including inversed-ratio ventilation, high-frequency ventilation, and ventilation via a double-lumen tube. On day 15 a bovine surfactant preparation (38 mg/kg body wt.) was instilled into both lungs. Initially there was deterioration of the pulmonary function, probably due to crusts in the bronchial mucous membrane. After aspiration of the crusts at bronchoscopy, there was progressive respiratory improvement. The inspired oxygen concentration and PEEP level could be reduced, and the ventilatory ratio normalised within 14 days. This therapeutic intervention improved pulmonary function and probably led to the successful outcome after 36 days of ventilatory support.

Accidents, Traffic↗
PubMed1991

[Optimized analgesic sedation techniques for ESWL].

Analgo-sedation for ESWL treatment has been associated with a variety of problems. Minimal invasiveness of this technique should combine with haemodynamic stability as well as with adequate oxygenation. Patient acceptance has to be considered as another important aspect. Our study demonstrates the effectiveness of an analgosedative regimen with regard to these aspects. 50 ASA I-III patients scheduled for ESWL treatment were randomly allocated to receive either no premedication (n = 25) or chlorazepam as oral premedication (n = 25). The analgosedative technique was identical in both groups, consisting of atropine 0.25 mg, droperidol 5 mg (2.5 mg, if body weight less than 60 kg), and alfentanil 10 micrograms/kg intravenously. If necessary, repeated boluses of alfentanil 5 micrograms/kg were administered up to a maximum of 2 mg. Heart rates, arterial blood pressures, and peripheral oxygen saturation were measured during treatment. Post-treatment, patients were interviewed to assess the quality of analgesia. The results showed that our analgo-sedative regimen is suitable for ASA I-III patients. Stable heamodynamic conditions and adequate oxygenation were achieved in all patients. Patient acceptance was good. Patients with anxiolytic premedication benefited in terms of reduction in blood pressure and heart rate. The study also showed that anaesthesiologists may underestimate the pain intensity experienced and assessed by the patient.

Aged↗
PubMed1991

[Muscle relaxation using atracurium in porphyria variegata--case notes].

A case is presented involving the use of atracurium (120 mg) as a muscle relaxant in a patient with known variegate porphyria. The concentrations of urinary porphyrins and porphyrin precursors did not increase after this anaesthetic, and no exacerbation of the disease was noted. This single case suggests that atracurium can be used safely in patients with porphyria.

Atracurium↗
PubMed1991

Clinical evaluation of electrostimulation anaesthesia for hysterectomy.

A prospective randomized study was undertaken to evaluate the efficacy of electrostimulation anaesthesia (ESA) when compared with neurolept anaesthesia (NLA). One hundred patients scheduled for hysterectomy received either ESA or NLA. Higher levels of mean arterial pressure and heart rate in the ESA group make this technique less suitable for patients with a history of arterial hypertension. A higher dose of muscle relaxants was used in the ESA group. Measured stress variables like plasma glucose, cortisol, and iron indicate maintenance of the stress response during ESA. The postoperative questionnaire revealed intraoperative recall in 12% of ESA patients. We conclude that "pure" ESA based on a N2O regimen should be avoided.

Adult↗
PubMed1991

[Non-surgical removal of a knotted Swan-Ganz catheter].

Intracardiac knotting is a rare complication of pulmonary arterial catheterization. This paper describes a 68-year-old male patient who had a 7-F Swan-Ganz catheter inserted via the internal jugular vein. The postoperative chest roentgenogram revealed a catheter knot in the right ventricle. Using fluoroscopy it was possible to pull back the knot up to the indwelling introducer. By pulling the knot against the introducer its size was reduced to a minimum. After this manoeuvre, both the introducer and the small knot could be withdrawn from the jugular vein without further incident. The possible complications of this method and of alternative techniques are described and discussed. Surgical intervention in the case of a knotted Swan-Ganz catheter may only be necessary when intracardiac fixing of the knot is encountered.

Aged↗
PubMed1991

[Decrease in the concentration of tobramycin, vancomycin and phenobarbital in administration with infusion filter].

To assess the loss of drugs to in-line filters, concentrations of tobramycin, vancomycin, and phenobarbitone were determined in vitro in samples recovered upstream and downstream of the filter. Binding of the drugs to new filters was higher than to used filters. With bolus administration, the concentrations of vancomycin and phenobarbitone were reduced by 1% when using old filters and by 4% when using new filters. Tobramycin concentrations were reduced by 7 and 12%, respectively. With continuous administration of the drugs, binding was highest during the first half hour. Differences between new and used filters were also seen with continuous administration: The cumulative loss was 5% higher with new than with old filters. This difference in binding between filters may stem from a saturation of free binding sites. Tobramycin showed the highest binding to the in-line filter. The extent of adsorption of tobramycin to intravenous filters may be considered moderately important in adult patients. The adsorption of vancomycin and phenobarbitone is not clinically relevant in adult patients.

Adsorption↗
PubMed1991

The influence of etomidate upon cerebral metabolites after complete brain ischaemia in the rat.

The influence of etomidate on post-ischaemic cerebral metabolism was examined in 1-year-old male Wistar rats. Ten rats were randomly allocated to each of three groups. Group 1 animals received etomidate for 60 min without undergoing cerebral ischaemia. In Group 2, there was a 60-min recovery period following 15 min of complete cerebral ischaemia. Etomidate was administered to Group 3 animals after 15 min of ischaemia. At the end of the study period, the brains were frozen in situ using liquid nitrogen. The cortex was then biochemically analysed. Considering glycolysis as well as the citric-acid cycle, the pattern of metabolite changes with etomidate application was almost identical to the pattern of spontaneous recovery. The content of energy-rich phosphates was reduced when Groups 2 and 3 were compared with the non-ischaemia group, indicating previous depletion of energy reserves of brain tissue. However, the energy charge as a parameter of energy balance had already been returned to normal values. We conclude that post-ischaemic application of etomidate has no favourable effect on recovery after complete cerebral ischaemia in the rat.

Animals↗
PubMed1990

[Transfusion-induced Yersinia infection].

After a primary operation for renal artery stenosis a 48-year-old woman had to be re-operated twice for renewed arterial stenosis and retroperitoneal bleeding. The patient's respiratory and cardiovascular functions were stable two days after the second operation and renal function was recovering. But because of suspected renewed bleeding a transfusion with erythrocyte concentrate was begun. Fifteen minutes later the patient started to shiver and this was followed by signs of cardiocirculatory decompensation under the picture of a septic-toxic shock. Laboratory tests did not indicate a haemolytic transfusion reaction. Controlled mechanical ventilation and circulatory drug support were required over the next two days, renewed anuria persisting for longer than a week. Microbiological tests of the erythrocyte concentrate demonstrated Yersinia enterocolitica, serotype 03. Questioning of the blood donor revealed a mild gastroenteritis at the time of donation. This case underlines the need of excluding donors, if only temporarily, when there is even slight suspicion of a Yersinia infection.

Blood Donors↗
PubMed1990

Clonidine as a sedative adjunct in intensive care.

A 63-year-old man underwent distal oesophagectomy and proximal gastrectomy. Postoperatively, controlled ventilation was necessary for 53 days because of anastomotic leakage. Multiple sedative regimens proved to be inadequate. By contrast, a fentanyl-midazolam combination with continuous supplementation of clonidine 0.014 micrograms kg-1 min-1 (1.44 mg 70 kg-1 24 h-1) was very effective in terms of sedation and pain relief. During combined fentanyl-midazolam and clonidine infusion, cardiovascular depression gradually developed over several days necessitating the institution of a dobutamine infusion (dose: 8-12 micrograms kg-1 min-1). Four attempts of abrupt clonidine withdrawal were followed by sympathetic overshoot reactions consisting of tachycardia, hypertension, agitation, and sweating. Discontinuation of clonidine was finally possible after a 12-day weaning period.

Clonidine↗
PubMed1990

Tussive effect of a fentanyl bolus administered through a central venous catheter.

One hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl 7 micrograms/kg via a central venous catheter, those in group B were given fentanyl 7 micrograms/kg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. In group A, 45.9% of patients coughed after injection of fentanyl; the mean onset time from the end of fentanyl administration to the beginning of coughing was 10.6 seconds. Only one patient in group B and no patient in the control group exhibited a cough response (p less than 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex.

Catheterization, Central Venous↗