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Biomedical subjects

H M Koning

Publications and source records attributed to H M Koning.

9 recordsLinked to original sources
PubMed1991

Ketamine as analgesic for total intravenous anaesthesia with propofol.

A prospective study of 18 patients who underwent noncardiac surgery was performed to study the use of ketamine as an analgesic during total intravenous anaesthesia with propofol. A comparison was made with the combination propofol/fentanyl. The propofol/ketamine combination resulted in haemodynamically stable anaesthesia without the need for additional analgesics. Postoperative behaviour was normal in all patients and none of the patients reported dreaming during or after the operation. Propofol seems to be effective in eliminating side effects of a subanaesthetic dose of ketamine in humans. We recommend the propofol/ketamine combination for total intravenous anaesthesia for surgery when stable haemodynamics are required.

Adjuvants, Anesthesia↗
PubMed1990

Fate of mass burn casualties: implications for disaster planning.

A survey of 11 fire disasters which have occurred since 1970, showed that incidents occurring outdoors resulted in larger numbers of hospital admissions, with more severe injuries, than incidents occurring indoors. While the majority of burn casualties sustained burns covering less than 30 per cent body surface area (BSA), outdoor disasters resulted in the admission of a significant number of patients with burns covering more than 70 per cent BSA. Expert triage may therefore minimize the requirement for specialized burn beds. However, the scarcity of burn facilities is such that involvement of distant centres may be anticipated following large disasters. While effective early management extends the time available for the dispersal of casualties, delays may be avoided by prior planning, especially if the international transfer of patients is envisaged.

Body Surface Area↗
PubMed1989

Is on-line monitoring of renal function possible?

Twenty patients who had undergone open heart surgery were studied in order to determine whether measurement of the combined urinary sodium and potassium concentration can be used to monitor renal function. The clearances of creatinine and the free water demonstrated a significant statistical correlation with the combined urinary sodium and potassium concentration. We conclude that measurement of the combined sodium and potassium concentration in the urine can be used as an indicator of renal function. Thus, measurement of the electrical conductivity in the urine might be suitable as an on-line monitor of renal function during surgery or in the intensive care unit.

Cardiac Surgical Procedures↗
PubMed1988

Indirect calorimetry in cardiac patients.

Nineteen patients following open heart surgery were studied for the influence of cardiac function on metabolism. Diminished cardiac index was associated with the following changes in metabolism: lowering of the energy expenditure, an increase in respiratory quotient and conversion from fat to carbohydrate metabolism. Protein metabolism remained unaltered. The changes are attributed to decreased oxygen transport to the cell ('stagnant hypoxia'). For the estimation of energy expenditure without calorimetry assessment of cardiac function is essential. A formula for predicting resting energy expenditure is given.

Adult↗
PubMed1988

Renal function following open heart surgery: the influence of postoperative artificial ventilation.

In order to detect changes in renal perfusion and function in the postoperative period of open heart surgery, a prospective study of 21 patients following open heart surgery was performed. Cardiac output, renal blood flow, glomerular filtration and renal function parameters were determined during intermittent positive pressure ventilation (IPPV), and during spontaneous ventilation (SV). During IPPV, renal perfusion was found to be substantially decreased. The glomerular filtration rate was also reduced, but to a lesser extent, implying that the changes were due to a selective increase in postglomerular vascular resistance. The clearances of urea and creatinine were decreased during IPPV, but the clearances of osmoles and potassium were higher. The reabsorption of sodium, potassium and osmoles were also decreased during IPPV, but not that of urea. These findings are consistent with the development of increased renal venous pressure during IPPV, caused by impeded venous return to the heart. In the low cardiac output range a cardiac index in excess of 0.5l/min/m2 during IPPV seems necessary to achieve the same renal perfusion as during SV.

Acute Kidney Injury↗
PubMed1987

The effect of hemodynamic factors on cardiac performance following open heart surgery.

Sixteen patients who had undergone open heart surgery were studied in order to determine the factors influencing cardiac performance in the postoperative period. Hemodynamic influences during and following cardiopulmonary bypass were found to be more important than the preoperative cardiac function. The flow rate used during cardiopulmonary bypass had a pronounced influence on the post-operative cardiac performance. A low flow can result in the development of vasoconstriction postoperative with an increased chance of low cardiac output. A high flow during bypass is recommended, and in the postoperative period vasoconstriction must be treated vigorously to forecome low cardiac output.

Cardiac Output↗
PubMed1987

Optimal perfusion during extra-corporeal circulation.

A multivariate analysis of 130 consecutive patients operated during one month in our hospital was carried out to determine the influence of age and blood flow during cardiopulmonary bypass on the renal response to cardiac surgery. The postoperative level of serum creatinine could be related to three variables: preoperative serum creatinine, age and lowest blood flow during cardiopulmonary bypass. A higher blood flow is needed during cardiopulmonary bypass in older patients and in patients with a raised pre-operative serum creatinine to prevent deterioration in renal function postoperatively. A nomogram is given for the lowest blood flow during CPB, corrected for age and the pre-operative serum creatinine level, which will result in a desired postoperative serum creatinine of 110 mumol/l.

Adult↗
PubMed1985

Serious acute renal failure following open heart surgery.

The influence of 51 preoperative, peroperative and postoperative variables on the development of serious acute renal failure (ARF) following open heart surgery was studied. Although a large number of significant variables was found, a logit-model with only 2 explanatory variables showed an almost perfect fit. With this model the chances of serious ARF up to 90% were estimated. The results suggest that a critical circulation is the main cause of serious ARF. Furthermore, a reduced ability to cope with a critical circulation without renal failure plays an important role in the pathogenesis. There is a higher risk of serious ARF for patients older than 70, especially when circulatory support with dopamine is needed.

Acute Kidney Injury↗