Biomedical subjects

H J Hartung

Publications and source records attributed to H J Hartung.

At least 19 recordsLinked to original sources

PubMed1992

[Ventilatory changes during laparoscopic cholecystectomy].

During the past 2 years in Europe and the USA laparoscopic cholecystectomy (LC) has become a widely practiced procedure. Nevertheless, the effects of long-lasting laparoscopic procedures on carbon dioxide elimination have not yet been systematically investigated. METHODS. Approval from the institutional research review board was obtained, as was written informed consent from the patients. Eleven patients undergoing LC were studied. Patient age ranged from 31 to 67 years. All patients received total intravenous anaesthesia (fentanyl, propofol, vecuronium, DHB). Controlled ventilation with a tidal volume of 12-14 ml/kg was administered. Before introduction of anaesthesia a cannula was inserted into the left radial artery. Blood gas analysis was undertaken just before introduction, just before insufflation of carbon dioxide, and thereafter at two intervals, after reaching an intra-abdominal pressure of 12 mm Hg, 15 min apart. Oxygen consumption and carbon dioxide output were measured using a calorimeter (Deltatrac TM, Datex). Intra-abdominal pressure was maintained at 12 mm Hg during the operation. RESULTS. After onset of the pneumoperitoneum inspiratory peak and plateau pressure showed an increase by more than 40%. During the operation respiratory minute volume had to be increased by about 30-40% to maintain normocapnia. Oxygen consumption remained nearly unchanged during the procedure while carbon dioxide output increased up to 38% 60 min after onset of the pneumoperitoneum. D(a-A) CO2 showed no significant change, indicating no increase in dead space. Beginning with the insufflation there was a significant increase in mean arterial pressure that lasted until the end of the procedure. CONCLUSION. The described effects of carbon dioxide insufflation, especially the extent of carbon dioxide resorption, define the need for careful monitoring of respiratory function during LC, especially in patients with preexisting cardiopulmonary disease.

Adult↗

PubMed1992

[Early prognosis of severe cranio-cerebral injuries].

Severe head injuries are still associated with a high mortality (30-60%). Depth and duration of coma are poor prognostic parameters because of therapeutic concepts such as sedation and mechanical ventilation. That is the reason why we looked for prognostic parameters that are independent of therapy and can be obtained during the normal routine at an ICU for head and trauma patients. METHODS. The medical records of 59 patients with severe head injury were studied and analyzed by statistical means. Exclusion criteria were, e.g., thoracic trauma or abdominal injury. All data tested are parameters routinely measured at our ICU. The statistical analysis was based on calculation of the odd's ratio and its range of confidence. RESULTS. We evaluated 16 parameters correlating to patient lethality. All of them can be obtained by routine diagnostic procedures, OP findings and intensive care monitoring. The relevant criteria that raise the mortality risk to 1.9-7.7 are: age, subdural hematoma, subarachnoid hemorrhage, brain edema, midline shift, pupillary reflexes, motoric answer to pain, hemisyndrome, intracranial pressure, heart rate, blood pressure, necessity for vasocactive drug application, coagulation tests, blood glucose and diabetes insipidus. CONCLUSIONS. The evaluated risk factors permit early estimation of the patient's outcome independent of therapeutical interventions. Further studies are necessary to create a score on the basis of the parameters found.

Adolescent↗

PubMed1992

[Total spinal anesthesia. A complication of lumbar catheter peridural anesthesia for postoperative analgesia].

A case of secondary subarachnoidal dislocation of a lumbar epidural catheter is reported. A 76-year-old female underwent resection of the sigmoid colon. In order to provide postoperative analgesia, an epidural catheter was inserted between the 3rd and 4th lumbar interspaces prior to induction of anaesthesia. Aspiration tests were negative twice and a test dose of 4 ml 0.5% bupivacaine produced no signs of anaesthesia. Thereafter, the operation was performed under balanced general anaesthesia. Prior to the end of surgery a total of 14 ml bupivacaine 0.5% was administered without significant cardiovascular depression. At the time of extubation the patient was awake and free of pain. There was no sign of respiratory depression or paralysis of the upper extremities. Three hours later in the recovery room the patient complained of pain. After a negative aspiration test 14 ml bupivacaine 0.25% was injected. Thirty minutes after injection apnea and cardiac arrest occurred. Resuscitation was immediately started, resulting in quick restoration of circulation and restitutio ad integrum. Aspiration at this time showed cerebrospinal fluid. The latency of the onset of total spinal anaesthesia and the rapid restoration of stable vital functions, was astonishing. It is essential to observe the common precautions such as an aspiration test without a filter, administration of a test dose, and titration of the injected amount each time the anaesthetic agent is applied via an epidural catheter.

Aged↗

PubMed1990

[Anesthesiologic complications in risk patients during and following upper and lower abdominal interventions].

It was the aim of this study to determine intraoperative and postoperative complications following lower abdominal or upper abdominal surgical interventions both quantitatively and qualitatively using the risk classification of the Mannheim risk check list. The types of surgical interventions in the upper and lower abdomen can be considered as comparable in respect of influence exercised on the homeostasis. The case records of 386 patients were evaluated retrospectively who had been operated on at the biliary tract, stomach (upper abdomen) or sigma, rectum or ileocaecum (lower abdomen). Preceding diseases were noted and recorded, and so were intraoperative and postoperative complications up to the 4th postoperative week. Statistical testing was effected by means of the chi-square test with alpha = 0.05. In accordance with the determined risk classifications, the incidence of preceding diseases increased for both the types of surgery (cardiovascular diseases and pulmonary diseases being the preliminary diseases recorded in this context). If intraoperative and postoperative complications are broken down, there is a dominance of bronchopulmonary complications after upper abdominal surgery postoperatively, and an equal distribution of overall intraoperative complications. The data prove that in assessing the risk according to the Mannheim risk check list, laparotomies of the upper abdomen are underestimated, so that this type of surgery should rank higher in risk check list than large-scale laparotomies at the sigma and rectum. Over and above this, the enhanced pulmonary risk of upper abdominal surgery continuous to be a proven fact.

Aged↗

PubMed1989

[Intra- and postoperative complications in infrarenal abdominal aortic aneurysms].

Patients scheduled for operation of an abdominal aortic aneurysm are a challenge to the anesthesiologist due to multiple coexisting diseases and serious intraoperative hemodynamic changes caused by cross-clamping. The aim of this study was to investigate the incidence of intra- and postoperative complications and to analyze the coexisting diseases in order to estimate complications and risks. PATIENTS AND METHOD: The charts of 72 patients scheduled for resection of an abdominal aortic aneurysm in 1984 and 1985 were retrospectively analysed. The patients are divided into 6 groups: E: elective operation; K: without pulmonary catheterization; N: emergency operation; R: ruptured aneurysm; D: acute dissection. The statistical analysis was performed by chi-square test. RESULTS: Patients monitored by Swan-Ganz catheter suffered more frequently from chronic obstructive or restrictive pulmonary diseases and coronary heart disease or cardiac failure. INTRAOPERATIVE COMPLICATIONS: Emergency patients showed more than twice as many intraoperative cardiovascular complications than scheduled patients; 3 fatal cases were observed in this group. Renal complications (anuria) occurred in 2% during elective operations and in 30% during emergency operations. POSTOPERATIVE COMPLICATIONS: Most of the postoperative complications - 75% - were associated with the cardiovascular system, followed by disturbances of gas exchange and hypoxemia. Two patients in group E had a short-lasting renal insufficiency; 1 patient died of myocardial infarction 3 weeks postoperatively. Emergency procedures were much more risky, with a 90% incidence of cardiovascular complications; 4 patients died within 5 days, 1 other after 1 week. Patients monitored by Swan-Ganz catheter showed more arrhythmias and hypotension than the others. Atelectasis was seen on X-rays in 46% of emergency patients, 35% of group P, and 2.6% of group K. CONCLUSIONS: Retrospective studies of special and high-risk patients are very useful in assessing the individual clinical standard, despite problems with data acquisition. This study permitted the assessment of perioperative complications and risks in these patients.

Aged↗

PubMed1989

[Fenoterol-induced lung edema during anesthesia in cesarean section].

Indications for anaesthetics and the beta-mimetic fenoterol, which is used to inhibit uterine contraction, are of interest for the anaesthesiologist because these drugs can be life-threatening. For this reason a case is presented showing the cardiopulmonary side effects connected with anaesthesia for Cesarean section. Detailed knowledge of the pharmacodynamics of this tocolytic is imperative to prevent avoidable errors during administration of anaesthesia.

Adult↗

PubMed1989

[The axillary brachial plexus block. A study of 178 patients].

Success rates and complications were studied in 178 patients scheduled for brachial block. METHODS. Patients of both sexes aged 9 to 79 years received axillary blocks in order to permit typical surgical procedures of the hand an forearm. The block was performed using the transarterial method described be Dejong. Half of the local anesthetic was administered anterior to and half posterior to the axillary artery. The incidence of successful blocks, latency time, and systemic complications were investigated; 14 days after the blocks, motor function and sensation were examined in order to evaluate the local neurological status. RESULTS. The rate of successful blocks averaged 79% using 40 ml 1% mepivacaine after 12 min latency; this rate was increased to 89% by administering a further 20 ml 1% mepivacaine. Disagreeable sensations from the operative field occurred in 5% and mild symptoms of cerebral toxicity in 2.8% of cases; 1.6% of patients had cardiovascular disturbances such as hypotension or arrhythmias. Local complications such as hematomas were found in 17.5% local pain in the axillary region in 15%, and long-lasting paresthesias in 12% of cases. DISCUSSION AND CONCLUSIONS. The 90% rate of successful blocks is comparable to the range of 86-98% presented in the literature. The success rate depends on the definition of successful block, the experience of the anesthetist, and the volume and concentration of the anesthetic solution administered. The incidence of systemic cardiovascular complications was similar to that in the literature, but we observed fewer symptoms of cerebral toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

[Clinical experiences with alfentanil for balanced anesthesia in upper abdominal surgery].

METHODS: Three randomized groups of patients scheduled for upper abdominal surgery received either an initial large bolus of alfentanil combined with low concentrations of isoflurane (group 1), an initial small bolus of alfentanil combined with 50% higher isoflurane concentrations than group 1 (group 2), or isoflurane without opioids (group 3). Blood pressure, heart rates, and anesthetic consumptions were measured and recorded, as were side-effects such as thoracic rigidity, bradycardia, and nausea, and postoperative recovery time. RESULTS: The mean isoflurane concentration in group 1 was 0.8 vol% combined with an average alfentanil bolus of 6.8 mg and three additional doses of 1.1-1.4 mg. Group 2 received a mean isoflurane concentration of 1.3 vol% combined with four additional doses of 1.3-1.7 mg alfentanil. Group 3 needed an average isoflurane concentration of 1.5 vol%. Side effects of alfentanil were prevented by atropine administration; severe complications were not observed. Postoperative recovery time showed significant differences between groups 1 und 2: group 1 patients were awake within 7.5 min and group 2 within 17 min after the operation. No respiratory depression was detected. CONCLUSIONS: Alfentanil combined with volatile anesthetics produced no severe side-effects in patients scheduled for upper abdominal operations. The pharmacokinetics of alfentanil are advantageous with regard to the postoperative period.

Alfentanil↗

PubMed1987

NAPROS: a semiautomatic user-friendly anaesthetic record system.

NAPROS is a semiautomatic, inexpensive, and easy-to-use anaesthetic record system. It is based on an ACORN (BBC-Model B) microcomputer that is linked to a non-invasive arterial pressure monitor (DIN-AMAP 845a) and an inhalation anaesthetic monitor (Engstroem EMMA) for automatic collection of measured data. The following functions have been implemented: Automatic registration of cardiovascular data and concentration of anaesthetic inhalation agents. Graphical or numerical representation of fluid-balances. Possibility to recall dosage information for drugs and drops. Printing of a final anaesthetic report at the end of anaesthesia. Definite advantages of NAPROS are: The number of hours saved by the computer record over manual data entry is 8 hours. - Better acceptance by users.

Anesthesiology↗

PubMed1987

[Modification of intracranial pressure by propofol (Disoprivan). Initial results].

The effects of propofol on intracranial pressure (ICP) were studied in seven patients with isolated intracerebral injuries. All patients had lost consciousness and were intubated and ventilated. On the basis of computed tomography (CT) of the brain, it was decided whether an implantation for epidural pressure monitoring was indicated. Implantation of the pressure transducer was followed by measurements of epidural pressure, blood pressure, heart rate, and blood gas analysis. Propofol 1 mg/kg body weight was administered and all parameters measured again 1, 3, 5, 10, and 15 min after dosing. The CT showed contusion bleeding and narrowed complemental space in all patients. The individual intracranial pressure profiles are shown in Fig. 1. Except for one patient who showed an extremely unstable and excessively high ICP even during subsequent thiopental treatment, no increase was observed after propofol. The cerebral perfusion pressure showed no relevant changes, nor did blood pressure or heart rate. It can be concluded from this study that propofol (ICI-Pharma) causes no ICP increase in patients with elevated ICP and may be used in these cases as an induction hypnotic.

Adult↗

PubMed1987

[Intracranial pressure in patients with craniocerebral trauma after administration of propofol and thiopental].

Propofol (Disoprivan) is a rapid and effective hypnotic comparable with etomidate. Up to now, the effects on intracranial pressure (ICP) have only rarely been investigated, especially in cases with pre-existing increased ICP [4, 18]. The aim of this study was the evaluation of ICP after i.v. propofol administration in comparison with thiopental. Method. Five patients were studied, all of whom had had isolated head trauma. All were on controlled ventilation and were unconscious. Depending on the result of computer tomography, an epidural pressure transducer was implanted. ICP, blood pressure (BP), and heart rate (HR) were measured before and 1, 3, 5, 10, and 15 min after 1 mg/kg propofol; subsequently 2 mg/kg thiopental were administered and the same parameters documented. Cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) were calculated. Results. ICP decreased in all five cases 5 min after the initial values were measured. Two patients showed an ICP decrease after thiopental. BP was reduced markedly by propofol and very slightly by thiopental. The CPP showed a small decrease in four patients after propofol and in two after thiopental. Conclusions. The data now available permit the conclusion that both propofol and thiopental can be used in patients with possibly elevated ICP. The marked cardiovascular side effects of propofol must be taken into consideration.

Adolescent↗

PubMed1987

[Complications of anesthesia in elderly patients].

Progress in surgery and anesthesia has contributed to lowering operative risk and expanding the indications for operations in higher age groups. The goal of treatment in the elderly is to achieve the best possible degree of reducing discomfort and increasing personal independence. Methods. A brochure with a clinical study on 1,021 patients chosen at random shows the frequency of complications arising during the peri- and post-operative course in patients around 60 years of age and older. Operative areas were general and emergency surgery, vascular surgery, neurosurgery, and urology. Operations were carried out in regional or general anesthesia. Patients were divided into groups below and above age 60. Evaluation of the data was carried out according to an integrated data processing concept. This program enables quantitative and qualitative data to be combined at will, taking into consideration that evaluating criteria can be varied considerably. Results. The results demonstrate that patients over 60 have significantly more complications than patients under 60. Analysis of the influence of the factors associated with surgical risk reveals that factors related to the operation such as type, length, and extent do not increase the risk as much as the numerous accompanying illnesses in both age groups. As far more elderly patients are affected by multimorbidity, the conclusion may be drawn that the increased risk observed is not due mainly to age, but rather to the patient's condition prior to surgery. The results indicate clearly that an exact analysis of the initial condition as well as avoiding failure or malfunction of certain organs must have priority in both age groups.

Aged↗

PubMed1986

[Effect of subpartal tocolysis on maternal cardiovascular parameters with subsequent cesarean section in general anesthesia].

The influence of subpartal beta-sympathicomimetic tocolysis on a subsequent Caesarean section with halothane as inhalational anaesthetic was examined in 42 pregnant women. Alterations in the heart rate, blood pressure and heart action during the operation were measured. 23 patients (group "bolus") received fenoterol monotherapy. In 19 patients (group "iv-tocolysis") fenoterol was combined with the cardioselective beta-1-blocking agent metoprolol. In comparison with these two groups, 25 pregnant women without tocolysis were examined as controls. There were only slight differences in heart rate and blood pressure between the three groups. Arrhythmias were registered in 42 percent of the cases, in most cases during light anaesthesia before delivery. Sinus tachycardias with a heart rate of 130 beats per minute or more were observed most frequently. Arrhythmias of ectopic origin and sinus bradycardias, however, were found seldom. The incidence of arrhythmias in the three groups during Caesarean section did not differ significantly. There was no evidence for an increased occurrence of arrhythmias following beta-sympathicomimetic tocolysis.

Adult↗

PubMed1986

[Axillary brachial plexus block with lidocaine HCl and carbonated lidocaine].

An accordance with the clinical examination recommended by Lanz and Theiss, we studied 26 patients undergoing a blockade of the axillary plexus with lidocaine-CO2 or lidocaine-HCl. Furthermore, we determined the blood concentrations of these local anaesthetics. The study showed no significant differences between the two groups of patients, except that the onset of the blockade was more reliable in one group. There was less impairment of motor function than sensory function. Blood lidocaine concentrations amounted to 2.46 mg/l (mean value) within 25 min. Slight cerebral intoxication could be seen in four patients, with no correlation with possibly high lidocaine concentrations. Lidocaine CO2 is recommended as a rapid blockade of short duration in outpatient regional anesthesia.

Adolescent↗

PubMed1986

[Modification of postoperative somnolence following halothane anesthesia by physostigmine].

In a prospective study the influence on awakening after halothane anaesthesia of physostigmine was investigated. Of a total of 62 patients 29 received physostigmine 2 mg i.v. prior to extubation, 33 were left without. The degree of awareness in the patients was determined by Erzigkeit's "Syndrom-Kurz-Test" (Quick Syndrome Test) (SKT). On preoperative testing by SKT both groups showed comparable degrees of awareness. At 45 and 90 min after extubation no statistical differences in the SKT were seen between the groups. If broken up for age over or below 60 yr, a tendency towards improved alertness in patients younger than 60 yr in the physostigmine group is apparent despite a slightly poorer performance preoperatively. In contrast in treated sexagenarians protracted awakening was observed. We tentatively conclude that central reactions to physostigmine in our patients were age-related.

Anesthesia, Inhalation↗

PubMed1985

[Cimetidine and ranitidine in intensive care patients. Double-blind randomized cross-over study on intravenous administration: hemodynamics, plasma coagulation, blood gases and acid-base status].

Intravenous cimetidine 200 mg, and ranitidine 50 mg were administered as 2 minute infusions to 50 intensive-care patients. Cimetidine and ranitidine differed significantly in their effect on systolic arterial blood pressure measured during the second minute (alpha = 0.01). In the case of cimetidine the haemodynamic parameters measured over 10 minutes revealed a clearly defined fall in systolic, diastolic and mean arterial blood pressure as well as a rise in heart rate. The initial values were regained 5 minutes after drug application. Adverse effects of ranitidine on haemodynamics were much less than those of cimetidine. Neither drug produced any essential change in clotting parameters (partial thromboplastin time, plasma thrombin time, thromboplastin time and fibrinogen) measured before and 5 minutes after application, nor had they any effect on blood-gases or acid-base status.

Acid-Base Equilibrium↗

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

[Prognostic significance of a preoperative risk check list].

The perioperative risk of lethal complications amounts to 0.02 to 0.4% dependent on different investigators. A further decrease of this perioperative risk has failed to occur in spite of most sophisticated methods of anesthesiology. We desire a safe classification of risk scores in order to calculate the prognosis of the individual patient who is scheduled for operation and anaesthesia. 15 anamnestical, clinical and blood chemistry data of 700 patients planned for general surgery were registered, intra- and postoperative complications were documented, and by means of statistical methods (discriminant analysis) evaluated. The patients' data were registered from the date of premedication to discharge or to four weeks after operation. To define the complications they were classified as mild, moderate and severe complications. The 15 variables used show a calculated risk prognosis of 40% for mild, 57% for moderate and 79% for severe complications. We find a very good correlation of the calculated versus observed risk of complications. The risk of mild complications are underestimated and severe complications overestimated.

Anesthesia↗