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Biomedical subjects

I Hass

Publications and source records attributed to I Hass.

13 recordsLinked to original sources
PubMed1997

Laryngo-pharyngeal complaints following laryngeal mask airway and endotracheal intubation.

STUDY OBJECTIVE: To investigate the incidence and severity of laryngo-pharyngeal complaints following anesthesia with the use of a laryngeal mask airway (LMA) compared with endotracheal intubation in adults. DESIGN: Prospective study with randomized patient selection. SETTING: University medical center. PATIENTS: 202 adult ASA physical status I, II, and III patients scheduled for elective surgery of either an extremity or breast, or a transurethral resection. INTERVENTIONS: Following intravenous induction of anesthesia, a standard LMA size #3, #4, or #5 corresponding to the patient's body weight, was inserted in 103 patients; 99 patients were intubated with a polyvinylchloride endotracheal tube [7.5 mm inner diameter (ID) in women and 8.0 mm ID in men]. Cuff pressures in the LMA group were initially reduced to a minimum pressure at which an air-tight seal between the LMA and the laryngeal inlet was provided at a positive pressure of 20 cm H2O during manual bag ventilation. Cuffs of endotracheal tubes were inflated and controlled to a volume needed to prevent gas leak at 35 cm H2O pressure. MEASUREMENTS AND MAIN RESULTS: Cuff pressures were continuously monitored in both groups. Patients assessed their laryngo-pharyngeal complaints on a 101-point numerical rating scale on the evening after surgery and the following two days. No difference was found in the incidence and severity of sore throat on the evening following surgery or on the two following days. Dysphonia was more frequent following intubation than following LMA insertion on the day of surgery (46.8% vs. 25.3%) and on the first postoperative day (28.1% vs. 11.6%) (p < 0.05). However, the incidence of dysphonia increased with the duration of anesthesia in LMA patients but not in intubated patients. The incidence of dysphagia was significantly higher following LMA insertion compared with endotracheal intubation on the day of surgery (23.8% vs. 12.5%), and on the first postoperative day (22.3% vs. 10.4%). The severity of the individual complaints of minor laryngo-pharyngeal morbidity was comparable between groups. The type of airway management during anesthesia did not affect patient satisfaction with the anesthesia received. CONCLUSIONS: There is a distinct pattern of laryngo-pharyngeal complaints following the use of the LMA and endotracheal intubation. With regard to minor laryngo-pharyngeal morbidity, the advantage of the LMA to endotracheal intubation is questionable.

Deglutition Disorders↗
PubMed1996

[Intraoperative airway obstruction during use of a laryngeal mask. A case report and fiber optic findings].

Laryngeal obstruction is a challenging complication during anaesthesia with a face mask or laryngeal mask and is due to insufficient analgesia in most cases. However, with a laryngeal mask in place it must be differentiated whether the airway obstruction is caused by the laryngeal mask itself or by other factors. Knowledge of the pathophysiology of the laryngeal closure and experience with the use of the laryngeal mask are essential for adequate treatment. Not the removal of a correctly inserted laryngeal mask which initially provided a satisfying airway, but the relaxation of laryngeal muscle activity by adequate anaesthesia is the first mandatory treatment if intraoperative airway obstruction occurs.

Adult↗
PubMed1996

A comparison of sevoflurane with halothane in outpatient adenotomy in children with mild upper respiratory tract infections.

STUDY OBJECTIVE: To investigate the efficacy and safety of sevoflurane compared with halothane in pediatric outpatient ear-nose-throat (ENT) surgery during the induction, maintenance, emergence, and recovery of anesthesia. DESIGN: Prospective, randomized, comparative, open-label study. SETTING: ENT operating room and postoperative recovery room at a university medical center. PATIENTS: 41 ASA status I and II children between the ages of 2 to 10 years, with mild upper respiratory tract infection (URI). INTERVENTIONS: Induction and maintenance of anesthesia with either sevoflurane or halothane for outpatient adenotomy, otomicroscopy, and myringotomy. MEASUREMENTS AND MAIN RESULTS: Induction (means +/- SEM) was significantly shorter in the sevoflurane group (2.6 +/- 0.2 minutes) than in the halothane group (3.2 +/- 0.2 minutes). There was no difference between the two groups with regard to complications that occurred during the induction and maintenance period. The time to emergence and recovery was significantly shorter with sevoflurane than with halothane (means +/- SEM; time to extubation 9.9 +/- 0.98 minutes vs. 13.4 +/- 1.06 minutes, time to eye opening 12.9 +/- 1.6 minutes vs. 24.5 +/- 1.8 minutes, command response time 20.7 +/- 2.5 minutes vs. 36.4 +/- 2.8 minutes). No difference in the incidence of complications during emergence and recovery was found. Evaluation of recovery as assessed by a modified Aldrete score showed that children who had received sevoflurane reached higher scores in the first 30 minutes following the discontinuation of the anesthetic. The Pain/Discomfort Scale demonstrated a difference in the sevoflurane group, with more children being agitated and restless. CONCLUSION: Sevoflurane provides a safe and rapid anesthetic induction with no differences in complications during the induction, maintenance, and emergence period. With sevoflurane, the time of emergence and recovery was significantly shorter. The characteristics of sevoflurane as evaluated in the present study make it a suitable anesthetic in pediatric outpatient surgery even in the presence of mild URI.

Adenoids↗
PubMed1996

Marked increases in heart rate associated with sevoflurane but not with halothane following suxamethonium administration in children.

The changes in heart rate and arterial blood pressure following the administration of suxamethonium in healthy children (mean age 3.8 +/- 0.3 years) during inhalational induction with either sevoflurane (n = 22) or halothane (n = 19) were studied. Heart rate 60s following suxamethonium administration increased significantly in the sevoflurane but not in the halothane group. In the halothane group, four children required intravenous (i.v.) atropine as as result of bradycardia. None of the children in the sevoflurane group developed bradycardia following suxamethonium (P < 0.05). Values of oxygenation, ventilation and age corrected minimal alveolar concentration were comparable at all measurement times. The haemodynamic response to the administration of suxamethonium in children anaesthetized with sevoflurane seems to reflect the stimulation of the autonomic ganglia by suxamethonium whereas this positive chronotropic effect is attenuated or reversed by halothane.

Anesthetics, Inhalation↗
PubMed1996

[Intubation trauma of the larynx--a literature review with special reference to arytenoid cartilage dislocation].

Trauma to the cricoarytenoid joint represents a rare but serious complication of endotracheal intubation. Subluxation and luxation of the arytenoid cartilage may occur during difficult but also following uncomplicated intubation. Forces on the arytenoid cartilage exerted by the laryngoscope blade or by the distal part of the endotracheal tube may cause anterior and inferior displacement of the arytenoid cartilage. Due to the conventional intubation technique the left arytenoid cartilage is affected most frequently. Posterolateral subluxation is attributed to the pressure exerted on the posterior glottis by the convex part of the shaft of the tube. Systemic diseases (e.g. terminal renal insufficiency, bowel diseases, acromegaly) may cause degeneration of the cricoarytenoid ligaments, thus making the cricoarytenoid joint more susceptible to traumatic dislocation. Persisting alterations of voice, sore throat and pain on swallowing may hint to the diagnosis of arytenoid dislocation. However, stridor and shortness of breath have also been observed. If pharyngo-laryngeal complaints persist, evaluation by laryngologists is mandatory. In addition to indirect and direct laryngoscopy, computerised tomography and electromyography of the larynx play an important role in differentiating arytenoid dislocation from true vocal cord paralysis due to nerve damage. Early operative reposition results in fair prognosis, whereas delayed diagnosis may lead to ankylosis of the cricoarytenoid joint with permanent impairment of the voice and possibly compromised airway protection.

Anesthesia, Endotracheal↗
PubMed1995

Feasibility and rate of leucocyte depletion with a single leucocyte depletion filter during massive transfusion.

BACKGROUND: The study examines the feasibility and rate of leucocyte depletion with a single leucocyte depletion filter in combination with the Level 1 heat exchanging infusion/transfusion device H-500/H-25i during massive transfusions. MATERIALS AND METHODS: LeukoGuard-6 filters (LG-6) were manufactured to fit the infusion sets of the Level 1 H-500/H-25i. This modified device was used intraoperatively in six patients with severe haemorrhage. Following determination of the white cell counts (WCC) in each buffy coat poor red cell concentrate prior to administration, WCC were then obtained from blood sampled directly distal to the filter after the first and after the last red cell concentrate was given. Leucocytes were determined in the Nageotte chamber and then calculated to determine leucocytes/250 ml (therapeutic unit). Parameters of feasibility (time for preparation of the system, the amount of transfused red cell concentrates, time interval of transfusions) were recorded. RESULTS: The mean volume of red cell concentrates which were transfused and filtered by a single filter was 2,708 ml (S.D. +/- 797 ml) within a mean time interval of 42.5 min (S.D. +/- 26 min). With a mean WCC of 1.17 +/- 0.68 x 10(9) leucocytes/250 ml in the red cell concentrate prior to filtration the LG-6 achieved a log-3 reduction of leucocyte counts. During the transfusion the WCC distal to the filter increased on average by a factor of 3 (from 0.9 x 10(6) leucocytes/250 ml following the first blood unit to 2.7 x 10(6) leucocytes/250 ml following the last), but remained below 5 x 10(6). CONCLUSION: Modification of the Level 1 H-500/H-25i system by incorporating the LG-6 leucocyte depletion filter provides a significant reduction of the WCC in the transfused red cell concentrates during massive transfusion. The rate of leucocyte depletion by a single leucocyte depletion filter achieves low leucocyte counts which are documented to be of therapeutical value. As the significance of leucocyte-reduced blood products for patients with haemorrhagic shock following trauma or major surgery has still to be elucidated, the presented device may be useful in the performance of future studies related to this subject.

Blood Volume↗
PubMed1982

Cardiovascular effects of epinephrine and dipivalyl epinephrine applied topically to the eye in patients with glaucoma.

The cardiovascular effects of topical ophthalmological preparations of 2% epinephrine (EPI), 0.1% dipivalyl epinephrine (DPE), and placebo were studied in double-blind fashion in 20 patients with glaucoma. Both drugs and placebo produced a decrease in heart rate (2 +/- 3 beats/min) which, although small, was highly significant (p less than 0.001). Neither drug not placebo produced a significant effect on mean or systolic blood pressure (BP) over the group as a whole (p greater than 0.1). However, 5 of 20 patients responded to EPI with a significant rise in mean or systolic BP (defined as a change greater than mean change +/- 2 SD), whereas there were no such responses to DPE or placebo. One patient developed marked ventricular ectopy after EPI. We conclude that EPI may cause cardiovascular side effects in a high percentage of patients (25% in this study) through individual susceptibility rather than a predictable effect. DPE, a new epinephrine analogue, appears to be devoid of these effects.

Aged↗
PubMed1980

Comparison between pilocarpine and timolol on diurnal pressures in open-angle glaucoma.

In 14 eyes with open-angle glaucoma, 2% pilocarpine hydrochloride given four times a day was compared with timolol given twice daily in its effect on intraocular pressure around the clock. The findings suggest that the timolol produced a greater reduction in pressure than pilocarpine and that, in 50% of the diurnal curves, the timolol curve showed smaller swings in IOP.

Circadian Rhythm↗
PubMed1979

Topical timolol in open-angle glaucoma.

Timolol theraphy was started in 37 patients with open-angle glaucoma whose intraocular pressure was inadequately controlled with maximum medical theraphy or who were having side effects with conventional medication. The intraocular pressure was substantially reduced by timolol in most of the patients, and there were relatively few side effect. A slight decrease in the pulse rate occured in some patients. The pressure-lowering effect was additive to that of other medications the patients were receiving, and was particularly useful in 13 of the 16 patients whose intraocular pressure had previously been inadequately controlled by maximum medical theraphy. The pressure-lowering effect appeared to be well sustained in most patients, although the pressure rose slightly in some.

Acetazolamide↗
PubMed1976

The role of vehicle safety glass in eye injuries.

Despite the introduction of compulsory seat belt legislation, the incidence of eye injuries, and their severity, is greater in Auckland, New Zealand, than in London, Canada. A comparison has been made between Auckland (83 cases) and London (50 cases) in a survey from 1 July 1970, to 31 December 1974. Consideration is given to the fact that New Zealand vehicles are equipped with heat-toughened (tempered) glass, whereas in Canada, vehicles are fitted with laminated windscreens.

Accidents, Traffic↗