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H Kuhnigk

Publications and source records attributed to H Kuhnigk.

6 recordsLinked to original sources
PubMed1994

[Cesarean section with subsequent craniotomy in the area of the posterior cranial fossa].

We report on a 31-year old pregnant patient with von-Hippel-Lindau syndrome who presented to the emergency room with symptoms of increased intracranial pressure. She was found in premature labour with a normal foetus of 29 weeks' gestational age in breech presentation. We discuss an anaesthetic and neurosurgical management during emergent craniotomy and Caesarean section. Caesarean section and posterior fossa craniotomy with resection of an angioblastoma are performed in one setting. Following rapid sequence induction with thiopentone and succinylcholine, anaesthesia is maintained with fentanyl, flunitrazepam and pancuronium; nitrous oxide and volatile anaesthetics are avoided. The advantages of this technique include haemodynamic stability and maintenance of intracranial pressure. Neonatal depression is likely with this technique and requires resuscitative measures. The indications for rapid sequence induction in pregnant patients with raised intracranial pressure at risk for aspiration are discussed. Different options for monitoring during this procedure are described.

Adult↗
PubMed1994

Skills and self-assessment in cardio-pulmonary resuscitation of the hospital nursing staff.

UNLABELLED: Differences in the success rates of the pre-hospital or in-hospital resuscitation attempts seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for pre-hospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. In this context, the resuscitation skills and the self-assessment of CPR methods of hospital staff were investigated. METHODS: during 53 CPR refresher courses offered to nursing staff members, the individual skills and competence in CPR procedures of 425 nurses were examined according to the standards and guidelines of the German Medical Association. During the first part of the study the participants were asked to subjectively rate their proficiencies in CPR followed by a practical assessment of their manual CPR skills by an independent observer. Scores were calculated for artificial ventilation and chest compression. Quality criteria were defined, grouped and analysed statistically by the chi-squared test. RESULTS: 16.2% of the participants felt sufficiently trained to perform CPR independently and 77.2% did not. Thirty-six percent estimated their CPR skills to be sufficient or good. Only four participants (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvres. The CPR skills did not differ with regard to the nurses' educational degree, professional experience, previous CPRs performed or work area within the hospital. Of the nursing staff, 6.6% were found to have good skills in artificial ventilation. The attempts at artificial ventilation made by 58.6% were completely inadequate. Correct chest compression was performed by 14.1%. The majority of the test group (44.7%) failed to carry out effective cardiac message. CONCLUSIONS: CPR skills of hospital staff are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost in spite of a positive self-assessment after a relatively short time. The results, however, do not suggest completely inadequate handling of CPR procedures in a hospital setting. Indeed, an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. As a consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made compulsory for nursing staff every 2 years.

Cardiopulmonary Resuscitation↗
PubMed1993

Studies of tissue PO2 in normal and pathological human brain cortex.

Brain cortex PO2 was measured after craniotomy and opening of the dura mater in 26 patients. We determined the brain tissue PO2 under standard narcotic conditions and after changing arterial PO2 and PCO2. Patients were divided into two groups (normal and pathological), depending on the aspect of their cortex on Ct/MRI and intraoperative appearance of the cortex. No statistical significantly difference was seen between tissue PO2 of the normal and the pathological group. A significant difference was seen only between the normal group and a subgroup with brain swelling (p = 0.0344). In the normal group no correlation was seen between tissue PO2 and arterial PO2 (r = 0.1541, p = 0.3076), whereas in the pathological group and especially in the oedema subgroup there was a highly significant correlation between tissue PO2 and PaO2 (r = 0.754, p = 0.0015 and r = 0.888, p = 0.0007). Breathing 100% oxygen changed tissue PO2 to 137.8 or 352 mmHg in the normal or the pathological group, respectively. Again, there was no correlation between tissue PO2 and PaO2 in the normal group (r = 0.1071, p = 0.392), whereas this correlation was significant in the pathological and the oedema subgroup (r = 0.6291, p = 0.0473 and r = 0.8385, p = 0.0185). This is evidence for regulatory mechanisms of tissue PO2. During hyperventilation no significant difference in tissue PO2 between the normal and the pathological group was seen. Low tissue PO2 values, however, indicate a risk for inducing ischemia.

Adult↗
PubMed1993

[Effect of external cervical spine immobilization on intracranial pressure].

We measured the intracranial pressure (ICP) in 18 patients with severe head injury in the neurosurgical intensive-care unit before and after placement of a rigid collar for cervical spine immobilisation. The purpose of the study was to determine whether the rigid collars, commonly used to, prevent cervical spine movement during transport to the treatment facility could lead to an increase in ICP. Patients who had an epidural transducer in place were studied and their ICP recorded during placement of either the Spieth cervical collar (n = 12) or the Philadelphia cervical collar (n = 6). The baseline ICP was 17.0 +/- 6.1 mmHg versus 17.7 +/- 6.4 mmHg 10 min after placement of the cervical collar 5 min after removal the ICP was 17.2 +/- 5.9 mmHg. No significant changes in ICP could be demonstrated during this study. Placement of the cervical collar is a simple and practical measure to immobilize the cervical spine during rescue and transport of intubated and ventilated patients. Its risk of increasing the ICT appears to be low even in the patient with severe head injury.

Adolescent↗