Biomedical subjects
Publications and source records attributed to H D Kamp.
Plasma concentrations of mepivacaine were determined after retrobulbar anesthesia. The measured maximal blood levels that can produce systemic side effects range from 1.23 to 4.88 micrograms/ml. We therefore recommend preoperative and intraoperative monitoring of arterial blood pressure and ECG.
Multimodal EPs and heart rate variability-measurements in comatose patients have been performed for few years at the university hospitals of Graz and Erlangen. The following data and parameters are analysed and discussed: brainstem auditory evoked potentials, mechanical evoked long-latency SEP, VEP recorded over the central and occipital region and heart rate variability (HRV). The method of data acquisition and processing is described and normative data are introduced. For the long-latency EP-components a signal-to-noise-ratio (SNR) is calculated. SNR is defined as ratio of the largest EP peak-to-peak amplitude and the mean amplitude (standard deviation) of a period prior to the stimulation. An unmeasurable or questionable EP is defined when SNR less than 2.6. For the vertex-SEP the following mean +/- standard deviation was obtained: SNR = 10.6 +/- 4.6; the vertex VEP was calculated with SNR = 7.0 +/- 3.0. The SNR of the bipolar recorded occipitally VEP was 3.9 +/- 2.0. Heart rate variability measurements in normal persons revealed the following mean +/- standard deviation at a heart rate of 67.8/min +/- 10.8/min: HRV = 7.8% +/- 2.5%.
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The effects of the inhalational anaesthetic, isoflurane, on two major parameters of respiratory mechanics--resistance and compliance--were studied in a total of 30 patients. With increasing inspiratory concentrations of isoflurane, resistance was measured in 5 spontaneously breathing patients using the oscillation method. In 16 mechanically ventilated patients resistance and compliance were calculated from airway pressure, gas flow, and tidal volume. In 9 patients with asthma or COPD the course of resistance and compliance was recorded intraoperatively. An increase in resistance of up to 117% of the initial volume occurred during spontaneous respiration, and was caused by a decrease in tidal volume. During mechanical ventilation with constant tidal volume, no definite changes in resistance or compliance were seen with increasing isoflurane concentrations. In the patients with elevated airway resistance there were only minor, statistically non-significant changes in resistance and compliance. The results show that the effects of isoflurane on respiratory mechanics do not differ from those of halothane or enflurane. Therefore, isoflurane may be considered appropriate for use in patients with impaired airway resistance.
In 40 patients who underwent large abdominal or thoraco-abdominal operations, the efficacy of intentional coughing was determined by recording the peak expiratory flow rate (PEFR) of two consecutive coughs. The measurements were made preoperatively and then 1, 2, 24, and 36 hrs. postoperatively. They consisted of two series, the first one completely uninfluenced, the second one following detailed instruction and manual assistance by the therapist. Before instruction, PEFR of the first cough averaged 5070 ml/s. and statistically significantly increased to 7100 ml/s. after instruction. The postoperative values decreased to about 30% of those found preoperatively. It was not before the first postoperative day that the values began to improve to above 40%. In all instances, the absolute PEFR-values of the first cough were significantly higher by 16 to 60% than those of the second one. From the results it is concluded that, after abdominal or thoraco-abdominal surgery, continuous instruction and assistance by the personnel are crucial for the efficacy of coughing.
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During a study of 130 patients undergoing hypotensive anaesthesia for oto-rhino-laryngological surgery the most important dose problems with sodium nitroprusside (S.N.P.) were characterized. In 14% of the cases more than 15 mcg/kg body weight/min S.N.P. were required. Our data show, that the smallest S.N.P. consumption occurs during neuroleptanalgesia in combination with 0.3--0.8 Vol-% enflurane. On the other hand, during neuroleptanalgesia alone, in several cases toxic amounts of S.N.P. would have been necessary to produce adequate hypotension. In such cases about 0.5 mg/kg body weight dihydralazine must be employed as a supporting agent for hypotension. The influence of this drug on the manoeuvrability of the low pressure state and on the administration of S.N.P. was investigated. Although, the equivalent amount of sodium thiosulfate (S.T.) did not increase the S.N.P. sensibility, its routine use is reconviended, since the combination of S.Th, and even higher doses of S.N.P. were tolerated without metabolic acidosis. As an alternative substance after long-term use of S.N.P. nitroglycerine should be used.
Pain-management in pediatric-oncological patients is an interdisciplinary task. The working group pain--therapy of GPO tries to work up an analgesic concept for this group of patients. Pre-existing experience in the therapy with sustained release Morphine and Metamizol should be considered. The documentation-system is just worked up, we ask all pediatric oncological groups to cooperate.