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Biomedical subjects

H Böhrer

Publications and source records attributed to H Böhrer.

158 records · Page 9Linked to original sources
PubMed1990

Impairment of left ventricular diastolic function during coronary artery bypass grafting.

Twelve patients were studied by transoesophageal Doppler echocardiography to determine diastolic function during coronary artery bypass grafting. Haemodynamic and Doppler-derived variables were measured after induction of anaesthesia and after closure of the sternum. Early diastolic filling of the left ventricle decreased from 55% to 35% during surgery. The contribution of atrial contraction to left ventricular filling increased from 41% to 62% (p less than 0.001). We conclude that coronary artery bypass grafting results in impairment of diastolic function during the operation.

Coronary Artery Bypass↗
PubMed1990

[Extracardiac risk factors in heart surgery--drugs].

Preoperative long-term medication continued during and after cardiac surgery may cause dangerous situations, including risks due to drug interactions, and risks as a result of contraindications to previously beneficial substances that develop during the surgical procedure. In the case of a lege-artis-performed anesthesia there is no urgent reason to postpone cardiac surgery because of previous drug treatment. Nevertheless, some compounds or groups of therapeutic agents can cause undue risk. These drugs are: acetylsalicylic acid (known to increase the bleeding tendency), and cardiac glycosides (which produces intraoperative dysrhythmias). Tricyclic antidepressants considerably intensify the effects of sympathomimetic agents. Monoamine-oxidase inhibitors, especially when combined with indirectly acting sympathomimetic agents or pethidine, may cause fluctuations of blood pressure that are difficult to control or can even precipitate a hypertensive crisis. In these cases preoperative discontinuation of drugs needs to be considered. The time of discontinuation must be chosen selectively for each active substance. The most important point for prevention of drug-related risk is to take a precise medical history, including previous drug treatment, in order to take future intraoperative precautions.

Contraindications↗
PubMed1990

[Continuous intragastric pH measurement in intensive care patients treated with ranitidine and tube feeding].

We studied 22 critically ill patients on long-term mechanical ventilation using continuous intragastric pH monitoring with an antimony electrode. Intragastric pH profiles were established for the duration of mechanical ventilation (mean: 7 days). The aim of our study was to achieve a gastric pH between 3.0 and 4.5 utilizing the H2-receptor antagonist ranitidine and nasogastric feeding with Nutricomp F. Patients were divided into three groups which were given (A) ranitidine boluses, (B) continuous ranitidine infusions, or (C) continuous ranitidine infusions together with enteral nutrition via the nasogastric tube. In group B we were able to obtain a pH value between 3.0 and 4.5 only in 11.6% of the observation period. With ranitidine boluses, there were even less measurements (9.3%) in the "optimal" pH range. The combination of continuous ranitidine application together with enteral alimentation made our attempts slightly more successful (20.0%). This failure to achieve the desired pH range encourages airway colonisation and nosocomial pneumonia at gastric pH greater than 4.5. At pH less than 3.0 there is a significantly higher incidence of acute stress ulcerations. Other therapeutic regimens e.g. the application of pirenzepine and sucralfate offer adequate protection of the gastric mucosa without raising the pH level.

Adult↗
PubMed1990

[A fatal hypertensive reaction during anesthesia in a patient with acute subarachnoid hemorrhage].

We describe the case of a 55-year-old female patient who presented for clipping of cerebral artery aneurysm that had ruptured 8 h before. Anesthesia induction was uneventful. After adequate positioning of the patient, two injections of a saline solution containing ornipressin (POR 8) were given into the scalp. Before surgical incision the patient developed a hypertensive reaction with arterial blood pressure of 230/140 mm Hg and heart rate 140/min. Pharmacologic intervention decreased the blood pressure and heart rate to normal values within 4 min. Upon surgical opening of the skull, the dura was found to be extremely noncompliant, and the pupils became wide and nonresponsive to light. Acute rebleeding was diagnosed, and the patient was sent back to the intensive care unit without clipping of the aneurysm and was declared brain-dead 12 h later. A Cushing response following acute rebleeding and other factors that might have caused the hypertensive crisis are discussed in detail. Anesthetic agents and adjuncts are assessed in terms of their influence on intracranial pressure and their protective action on the brain. Special consideration is given to subcutaneous ornipressin injection, which is known to be associated with cardiovascular side effects. Deep neuroleptanesthesia is recommended as the anesthetic technique of choice for clipping of cerebral artery aneurysms. Antihypertensive agents without cerebrovascular side effects should be used to treat hypertensive reactions.

Anesthesia, Inhalation↗
PubMed1989

Serum aluminium levels of intensive care patients treated with two different antacids for prevention of stress ulceration.

We studied the serum aluminum levels of 30 intensive care patients receiving six daily doses of magaldrate (Riopan) or aluminium hydroxide (Trigastril). In both groups we found a significant rise of the serum aluminium concentration (p less than 0.01) following administration of the antacid solutions. Examination on day 9 and 15 the magaldrate group showed significantly (p less than 0.05) lower aluminium levels than the aluminium hydroxide group. An increase up to the critical serum aluminium level of 100 ng/ml occurred in none of the patients that all had normal or slightly impaired renal function. Therefore routine measurements of serum aluminium levels in patients without renal impairment are not considered necessary following antacid therapy. However, we recommend the use of antacids with an aluminium absorption rate as low as possible.

Adult↗
PubMed1988

[Adsorption of insulin to the Perfusor systems].

Using radioimmunoassay determination we examined the recovery rate of 100 units of regular insulin that had been added to 50 ml. of a carrier solution in a plastic Perfusor syringe. We measured the recovery rate with sodium chloride 0.9% as carrier and after adding albumin (10 g./l.) and gelatine (6 g./l. resp. 12 g./l.). An initial insulin loss of 26% (with albumin) to 37% (with gelatine) was followed by only a small loss (less than 9%) during the next 24 hours. We conclude from our results that it is unnecessary to add substances with high molecular weight in order to reduce insulin adsorption to Perfusor systems.

Adsorption↗
PubMed1987

[Direct observation of microcirculation in isoflurane anesthesia].

The effects of anaesthesia with 1.0 vol% isoflurane or 0.7 vol% halothane on the microcirculation were studied in the dorsal skin fold chamber of 15 awake Syrian Golden hamsters. To avoid relative hypovolaemia hydroxyethyl starch (HES 450/0.7) was infused to keep the CVP at baseline level. Arterial blood gas values did not change with either of the anaesthetic agents. Mean arterial pressure decreased significantly with isoflurane to 79% of baseline. Small arteries (25-100 micron) did not exhibit any alterations of diameters in both groups, whereas arterioles (less than 25 micron) constricted with isoflurane from 15.5 to 13.3 micron (15 min) and to 12.0 micron (60 min). 10 min after stopping isoflurane further vasoconstriction was regularly noticed (from 51.0 resp. 15.5 micron to 36.6 resp. 9.7 micron) which did not occur after halothane. Spontaneous arteriolar vasomotion was abolished by halothane, but not by isoflurane; in two animals its amplitude increased. Capillary density rose with both anaesthetics: 9.1% (15 min) resp. 9.0% (60 min) with halothane, 14.0% resp. 17.3% with isoflurane. Local tissue pO2 measured in 6 additional hamsters increased during isoflurane from 16.4 to 22.8 mmHg (15 min) and 19.8 mmHg (60 min). It is concluded that isoflurane is less detrimental to local perfusion control than halothane. The preserved regulatory capacity results in a redistribution of microvascular flow and an improvement of oxygen supply to the dorsal skin fold chamber despite arterial hypotension.

Anesthesia, Inhalation↗
PubMed1986

[The history of anesthesia at the Heidelberg University].

An account is given on the development of general anaesthesia at the university clinics of Heidelberg. During the last century mainly chloroform was employed for general anaesthesia. Important events were the first demonstration of Koller's local anaesthesia in the eye in 1884, the first intubation for anaesthesia in Heidelberg, performed by F. Kuhn of Kassel and the development by M. Neu of a rotameter apparatus for nitrous oxide/oxygen anaesthesia in 1910. From 1932 on the surgeon M. Kirschner advanced the methods of high pressure infiltration for regional anaesthesia and segmental hypobaric spinal anaesthesia. In 1951 K. H. Bauer requested R. Frey to set up an "anaesthesia squad" consisting of 2 physicians and 3 nurses to become the nucleus of today's Institute of Anaesthesiology, with O. H. Just as its first professor and chairman.

Anesthesia↗
PubMedDate not supplied

Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone.

Sepsis is usually treated with surgical drainage, antibiotics, oxygenation optimization and volume resuscitation. Recent monoclonal and polyclonal anti-bodies have been used to treat sepsis by neutralizing the endotoxins and cytokines found in septic patients. This method does not significantly reduce mortality except in certain sub-populations of the treatment groups. We introduced a combination approach for sepsis treatment. This adjuvant therapy consists of polyclonal human immunoglobins together with infusion of low-dose hydrocortisone. This paper reports the results of this treatment in two different cases.

Anti-Inflammatory Agents↗