PubMed Health⌕ Search

Biomedical subjects

H J Bender

Publications and source records attributed to H J Bender.

17 recordsLinked to original sources
PubMed1992

Intelligent alarms reduce anesthesiologist's response time to critical faults.

The proliferation of monitors and alarms in the operating room may lead to increased confusion and misdiagnosis unless the information provided is better organized. Intelligent alarm systems are being developed to organize these alarms, on the assumption that they will shorten the time anesthesiologists need to detect and correct faults. This study compared the human response time (the time between the sounding of an alarm and the resolution of a fault) when anesthesiologists used a conventional alarm system and when they used an intelligent alarm system. In a simulated operating room environment, we asked 20 anesthesiologists to resolve seven breathing circuit faults as quickly as possible. Human response time was 62% faster, decreasing from 45 to 17 s, when the intelligent alarm system was used. The standard deviations in response time were only half as large for the intelligent alarm system. It appears that the computer-based neural network in the intelligent alarm system diagnosed faults more rapidly and consistently than did the anesthesiologists. This study indicates that breathing circuit faults may be more rapidly corrected when the anesthesiologist is guided by intelligent alarms.

Anesthesiology↗
PubMed1986

[Possibilities of computer use in anesthesia and intensive care medicine].

Today anaesthesiologists are on familiar terms with computers. In fact, computer technology has come to stay especially in the monitoring and documentation of measurement data; no new developments in this field are possible without the aid of computers. Computer-monitored respirators, infusion pumps or anaesthetic vaporizers have been developed and tested in practice, but their use is at present still restricted to a small select circle of specialists. However, their routine use can be expected in the very near future. In the fields of training and communication of knowledge, computers are still in the developmental stage. Although so-called "expert systems" are already in use in certain fields of medicine, their application in anaesthesia remains an exception. Progress in this direction does not really depend so much on the availability of suitable computers--they are in fact already in operation. The crux of the problem will be the readiness of anaesthesiologists and anaesthesists to feed the computers with appropriate programmes and to accept computers as partners in their work and in the field of training.

Anesthesia, General↗
PubMed1985

[Use of computer technology in training assistants in the anesthesia department].

The growing importance of computer technology in the fields of medical diagnosis and monitoring cannot be disputed. Few studies, however, have investigated the usefulness of computers in medical education. The following paper presents a teaching program for novice anaesthesists which helps demonstrate the problem of anaesthetizing high risk patients and conveys general guidelines for preoperative diagnosis and intraoperative monitoring. All data registered can be displayed on several video screens simultaneously. A printout of the guidelines is also available. Initial impressions of the program are presented.

Allied Health Personnel↗
PubMed1985

[Transdermal scopolamine (TTS-scopolamine) for the prevention of postoperative nausea and vomiting].

Parenteral scopolamine lost its significance for premedication because of severe side effects, at least in German speaking countries. The drug is now available as a transdermal therapeutic system (TTS-Scopolamine) which provides constant low plasma concentrations for three days, high enough to act as an antiemetic but low enough to be free from severe side effects. In a double blind study against TTS-Placebo TTS-Scopolamine was investigated in 40 patients, undergoing minor gynecological surgery. The anaesthetic procedure was standardized with alfentanil, etomidate, N2O and, if needed, Ethrane, drugs which have a moderate to strong emetic action. The premedication consisted of Flurazepam (evening) and diazepam (morning). The dosages were standardized. TTS-scopolamine was statistically significantly superior to TTS-placebo with respect to the antiemetic action and the judgment by the anaesthetist. Intraoperative complications such as thoracic rigidity and bradycardia were more frequent in the placebo group. There were no severe side effects. TTS-scopolamine can be recommended as an antiemetic for premedication, especially when benzodiazepines are used for the relief of anxiety. It should be administered on the evening before and can be removed one or two days after surgery.

Administration, Topical↗
PubMed1984

[Perspectives in the use of computers in anesthesia].

The remarkable development of computer technology and the early experiments into its clinical use give us cause ot define useful spheres of application and task areas in anaesthesia for this valuable machine. Parallel to this followed the development of computer use in anaesthesia. Here, there are essentially four main areas of application: administration of data, monitoring, teaching, process of decision making. Next to a quite uniform definition of the task areas of a computer, the question of the selection of the suitable computer for the respective requirement cannot be answered in the same uniform way. For the application of computer technology in the practice of anesthesiology it is essential to guarantee not only sufficient safety of data but also a protection from misuse and manipulation. On the whole it is probable that computer technology will take over more and more medical technical tasks especially of the anaesthesia apparatus and evaluate them. An automatic registration of records with combined off-line and on-line recording of measured values represents the logical development of this technology.

Anesthesia↗
PubMed1984

[The anesthesia protocol].

It has long been recognised that it is necessary to document all medical actions. Every anaesthesia is to be documented on an anaesthetic transcript. Such a transcript has various purposes. It serves principally as an adequate patient-support, but also has administrative, statistical, scientific and forensic purposes. The transcript used at the Mannheim Klinikum is a printed form, which, apart from recording intra-operative events, also has room for entering pre- and post-operative test results. The recording of an anaesthetic transcript is an essential part of the duties of the anaesthetist in the clinic. Today, with the application of the most differentiated administrations of narcosis, it would seem that we can no longer do without a properly made anaesthetic transcript.

Anesthesia↗
PubMed1983

[Effects of positive end-expiratory pressure (PEEP) or prolonged inspiration time on lung mechanics, gas exchange and hemodynamics in differential pulmonary ventilation].

In the case of patients with unilateral lung disorders one must anticipate a further increase in the intake volume of the more elastic lung and a decrease in intake volume of the less elastic lung when the inspiratory pressure is increased or the inspiratory time is extended within the framework of mechanical ventilation. Therefore, differential pulmonary ventilation lends itself for the treatment of unilateral damage of the lung by enabling the selective application of a positive end-expiratory pressure or an inverse inspiratory time. For a better understanding of the overlapping pathophysiologic reactions, the changes in lung mechanics, haemodynamics and gas exchange were measured on the healthy lung with unilateral application of a positive and expiratory pressure or an increased inspiratory time. Thirteen male and female patients, who had to undergo intracranial surgery were ventilated with two synchronized servoventilators using a Carlens tube. The positive end expiratory pressure varied in the right lung in spans of 6 cm each, 0-12 cm H2O, inspiratory time varied 34-70%. The left lung was ventilated with a 35% inspiratory time and an end expiratory pressure of 0. The respiratory intake volume was divided up into 45% (left lung) and 55% (right lung) based on the physiological difference in size between the left and right lung. Our results show that a directed unilateral application of a positive end expiratory pressure or an increased inspiratory time does not have any relevant damaging effects on the other lung. It can be expected that in the case of non-differentiated mechanical ventilation the ensuing unequal distribution of alveolar ventilation and perfusion with consecutive increase of intrapulmonary shunt volume can be decreased by the discriminate treatment of each lung.

Adult↗
PubMed1983

[Is the demand for a preoperative routine examination program justified?].

In a retrospective study with 136, 943 general and regional anaesthesias we demonstrated that the frequency of intraoperative cardiovascular complications is directly connected to the quality of preoperative examination and therapy proceedings. In addition to a careful preoperative clinical examination, a routine examination programme (REP) therefore should be carried out which determines relevant functional disorders of the essential organs and which gives the essential condition for an optimal preparation for surgery.

Anesthesia, Conduction↗
PubMed1983

[Time and incidence of peroperative cardiovascular complications in geriatric patients].

The incidence of intraoperative and postoperative complications was determined in a retrospective study via data evaluation by computer. Two groups of patients were examined, one group comprising patients below 60 years of age, whereas the other group consisted of persons above 60 years of age. The results show that complications of the cardiovascular system are three to four times more frequent in patients older than 60 years; severe hypotension or hypertensive reactions were seen in 2.9 and 9.3% of the patients, respectively, while arrhythmias occurred in 3.9%. No differences could be found in respect of the time at which these complications became manifest (intraoperatively or in the recovery room). Enumeration of the secondary diseases covered by this study, reveals significant differences; this can explain the limited range of compensation in persons of advanced age. Hence, an optimal preanaesthetic treatment and diagnosis, as well as monitoring are mandatory in geriatric patients to ensure safe anaesthesia.

Age Factors↗
PubMed1983

[On-line acquisition of haemodynamic and respiratory data during anaesthesia].

A system is presented which in connection with monitors commonly used affords high resolution control of pulmonary mechanics, respiratory and haemodynamic parameters during surgery. Extent of monitoring as well as choice of the parameters to be monitored is not determined by the system but by the physician concerned. The essential part of the system is a microprocessor in control of all monitors connected, which can store the accumulated data for a 24 hour period. On application in over 200 anaesthetics acceptance by the user was good. Because of the still rather complicated technical procedure use of the system during minor surgery proved to be difficult.

Anesthesia, General↗
PubMed1983

[Development and use of a computerized anesthesia protocol].

The real-time anaesthetic record allows the continuous on-line monitoring and the informative graphical presentation of important anaesthetic parameters; in this respect it is superior on the conventional made record. Preoperative findings and personal data of the patient are documented and presented by the aid of formulas on the terminal screen in addition to the on-line parameters and intraoperative off-line data e.g. drugs infusions, urine production, blood loss. The concept of the system is based on a microprocessor which is linked to daily used monitors by an analog-digital-converter. The wide use of the automatic record requires a relative high standard of monitors (e.g. mass spectrography), such that the applicability is limited to very extensive procedures of high risk patients.

Anesthesiology↗
PubMed1982

[Incidence of complications with plexus anaesthesia; a computer-assisted evaluation (author's transl)].

4,042 plexus anaesthesias were analysed for systemic complications by means of computer-assisted data processing. This allowed the large case material to be analysed statistically in great detail. The incidence of complications of this anaesthetic technique and the advantages arising from computer-assisted data processing are reviewed. Specific problems due to technical factors were also investigated.

Anesthesia, Conduction↗
PubMed1982

[The risk of anaesthesia. Investigations based on 153,660 anaesthetic procedures (author's transl)].

153,660 protocols of general and local anaesthesias were evaluated according to the complications observed during anaesthesia. The complications recorded were analysed with respect to the following criteria: type of anaesthetic procedure, experience of the anaesthesiologist, urgency of the operation and pre-operative condition (risk group) of the patient. The study shows that under the requirements of anaesthetic treatment at a university clinic, the degree of risk connected with anaesthesia is only slightly dependent on the type of the anaesthetic procedure and the experience of the physician performing the anaesthesia. Distinct differences in the complications recorded are found to be dependent on the urgency of the operation (cardiovascular and technical complications) and on the pre-operative condition of the patient (cardiovascular complications). A further decrease of the anaesthetic risk is only possible if all measures for optimal preparation before an operation are fully met and compromises are avoided to the utmost. However, spectacular improvement must not be expected with these measures.

Anesthesia↗
PubMed1980

[Data processing system for patients requiring artificial ventilation (author's transl)].

In the surgical intensive care unit of the Mannheim medical Centre a computer program has been developed to assist in the management of patients suffering from ARDS. It is based on a Dietz MUL-TI-USER system. 34 parameters of pulmonary mechanics, hemodynamics and blood gases were recorded off-line routinely. From these data 8 parameters were calculated according to established physiological relationships. Apart fom normal data printout a terminal scope offers graphical display of the interaction of any two parameters chosen. Data may be averaged regarding single patients, groups of patients or time. Data may be stored as hard copies. Operating instructions are very simple. Off-line data feeding is of advantage regarding data allocation, Calibration and plausibility control. We report on the development of the off-line computer system and on clinical efficiency and accuracy of the system in the treatment of patients in respiratory distress.

Adult↗