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Biomedical subjects

H Unseld

Publications and source records attributed to H Unseld.

16 recordsLinked to original sources
PubMed2000

[Epidural abscess following repeated epidural catheter placement for delivery].

This case report describes an epidural abscess with pseudomonas aeruginosa after the placement of two epidural catheters within one hour in a healthy 29-year old primipara. Spontaneous delivery occurred after an episiotomy about 4 hours later. Afterwards the epidural catheter was removed completely and again 5 hours later the woman was discharged from the hospital. On postpartal day 3 the patient experienced lumbar back pain, slight weakness of both legs and some difficulties to urinate. On day 14 after delivery magnetic resonance imaging revealed an epidural abscess at the height of the 4th and 5th lumbar vertebrae. Immediately a neurosurgical debridement and drainage was performed. The patient was discharged at home on the 10th postoperative day without neurological sequelae. In this case report a hematogenic infection was considered. The traumatized tissue from the two catheter placements within one hour could easily be colonized with pseudomonas aeruginosa originating from a transient bacteriemia due to an episiotomy inspite of adequate local disinfection measures. The case report also underlines the need for proper information of the patient about the possibilities of complications after epidural anesthesia in outside patients.

Abscess↗
PubMed1988

[Unrecognized esophageal intubation. Consideration of prevention in a case].

A case of unrecognized esophageal intubation is presented to point out that auscultation of the chest is not a reliable method for proving the correct position of the endotracheal tube in every case. Because of auscultatory findings in this case of a 47-year-old women, several warning signs were discarded: (1) the surgeons questioned about the possibility of ventilating the stomach during preparation for an abdominal hysterectomy; (2) failure of measuring expired CO2 with an infrared CO2 analyzer, which then was called defective; (3) cyanotic blood at skin incision. All signs were denied by the anesthesiologist after having repeatedly auscultated the chest and being sure of hearing normal breath sounds. Although in his 1st year of anesthesia training, he did not feel it was necessary to call the supervising anesthesiologist. At the time of cardiac arrest about 15 min after intubation, the incorrect tube position was discovered and corrected. Despite successful cardiac resuscitation, the patient did not regain consciousness and died 9 months later. The only reliable means of being sure that tube position is correct is to repeat direct laryngoscopy and visualize the tube inside the glottis or, alternatively, to perform expiratory CO2 measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1986

[Respiratory minute volumes following end expiratory CO2 values in artificial respiration in anesthesia].

During artificial ventilation of anaesthetised patients the respiratory minute volumes were estimated after end tidal CO2-values (eeCO2) and correlated to arterial blood gases. In men the mean respiratory minute volume of 130 ml/kg body weight (b.w.) was significantly above the 113 ml/kg b.w. of women. 9.7-year-old boys and 16-year-old men had higher minute volumes (178 ml/kg b.w. and 148 ml/kg b.w. respectively) in comparison to men of 23 years of age. In contrast, no significant difference was seen in the older age groups. Overweight men had a significant lower respiratory minute volume (114 ml/kg b.w.), as compared to normal body weight (128 ml/kg b.w.), but overweight women had no significantly different minute volumes compared to normal body weight. During the course of anaesthesia for vaginal hysterectomy the respiratory minute volume had to be reduced in the first and second hour as compared to controls before the start of operation, in order to avoid excessive hyperventilation. EeCO2-values of 3.8 to 4.2 per cent by volume stand for a very marked hyperventilation in the pulmonary healthy patient. The arterial alveolar difference of the CO2 pressure (aADCO2) was in the normal range between 1 and 5 mmHg. The end tidal CO2 estimation is a noninvasive and suitable method to exactly meet the ventilatory needs of the anaesthetised patient.

Adolescent↗
PubMed1985

[Vasospasm following liver rupture, dopamine and hydergine infusion].

A severe vasospastic reaction in both legs in the course of intensive-care therapy in a 16-year old patient with polytrauma is described. Since vasopathy was completely absent in the angiograph, a drug-induced cause is discussed. Dopamine and Hydergin, or a combination of both, were the mainly suspected drugs. Therapeutic measures included nitroglycerin given intravenously and lidocain intraarterially, leading eventually to "restitutio ad integrum".

Adolescent↗
PubMed1981

[Resuspension of erythrocyte concentrates: clinical examinations with human albumin and oxypolygelatine].

The acid-base status of packed red cells and the influence of resuspension with human albumin, oxypolygelatine (Gelifundol), Human-serum and physiological saline were examined. It was found that the severe metabolic acidosis of packed red cells increased only slightly with storage time, while the resuspension exerted divergent effects: Human albumin and physiological saline increased the metabolic acidosis slightly, but significant. Humanserum and oxypolygelatine diminished it because of their bicarbonate content. The clinical significance especially in massive transfusion is discussed.

Acid-Base Equilibrium↗
PubMed1981

[A computerized questionnaire to the anaesthetic record (author's transl)].

To the Anaesthetic Record of the Kreiskrankenhaus Donaueschingen a questionnaire was developed and used during te years 1978 and 1979 to compute the yearly reports of the whole anesthesia department as well as for each anesthesia resident. The various anaesthetics and techniques formed the basis of our data retrieval program. The questionnaire allows the computation of the annual reports in a simple and time saving way. Only one punch card is used; the rate of error is small. Since coding can be done by the anaesthesist himself or the nurse anaesthesist, no additional coding personnel is required.

Anesthesia↗
PubMed1979

[Severe complications after caval vein catheterization (author's transl)].

In 13 autopsy cases after catheterization of the superior caval vein a surprisingly high rate of incorrect positions of the catheter tip within the right atrium was seen. This had resulted in wide spreaded lesions of the endocardium and in voluminous thrombosis around the catheter tip. In one case a pericardial serous effusion with letal cardiac tamponade was found because of such malpositioning of a caval catheter. The mechanical stress to the endothelium by the catheter tip is held responsible for the intima lesions in the right atrium. The need for X-ray-control of the catheter position and its fixation at the site of entry through the skin is stressed.

Aged↗
PubMed1975

[Clinical investigations of the temperature effects of ketamine and halothane in children (author's transl)].

In 68 from 1- to 14-years-old children rectal temperature was measured in Ketamine and Halothane anesthesia and with room temperatures ranging from 22-25 and 26-28 degree centigrade, while orthopedic repair operations were performed on the extremities. Independent of the quality of the premedication, which consisted either of Ketamine (Atropine or Thalamonal) Atropine a significant rise in temperature of 0,4 to 0,5 degrees C. was found within one hour of Ketamine anesthesia, but only with room temperatures of 26-28 degrees C., while with lower room temperatures (22-25 degrees C.) rectal temperature remained unchanged. The rise in temperature occurred both in Ketamine monoanesthesia with spontaneous respiration and in Ketamine-N2O-O2 anesthesia with respiration controlled.

Adolescent↗
PubMed1975

[The influence of hydroxyethyl starch solutions on circulation and on kidney function in hypovolaemic patients (author's transl)].

In a group of 12 hypovolemic patients some parameters of circulation and kidney function were measured before and after an infusion of 1000 ml 6% hydroxyethyl starch solution (HES) was given. There were found increases in cardiac output, centralvenous pressure and endogenous creatinine clearance, and decreases of total peripheral resistance and shock index. Under the conditions of this investigation HES solution showed good properties as a plasma substitute.

Blood Circulation↗