PubMed Health⌕ Search

Biomedical subjects

I Wickström

Publications and source records attributed to I Wickström.

32 records · Page 2Linked to original sources
PubMed1982

Treatment of antidepressant poisoning with resin hemoperfusion.

1 The object of this study was to evaluate hemoperfusion in tricyclic antidepressant (TCA) poisoning. 2 Eight patients with severe TCA-poisoning and one patient with maprotiline poisoning were treated with resin hemoperfusion (HP). All patients were in Grade III or Grade IV coma with a QRS interval of 100 ms or greater. Hemoperfusion was started and continued until a satisfactory clinical response was obtained or for up to a maximum of 4 h. 3 Clearance values and extraction ratios were calculated during HP. The extraction ratio for all drugs was high (0.91-0.98) showing an effective clearance of these drugs from the blood compartment. After termination of HP a rebound effect of blood concentrations was seen in five cases. The total amount of the drug recovered was in no case greater than 3.1% of the estimated amount ingested. 4 It is therefore difficult to ascribe the clinical improvement seen in these patients during HP to the removal of significant amounts of the drug taken.

Adult↗
PubMed1982

Resin hemoperfusion in chloroquine poisoning.

A 46-year-old woman was admitted after ingestion of 10 g chloroquine phosphate. The patient's clinical condition deteriorated with characteristic ECG changes, low blood pressure, and respiratory depression. Resin hemoperfusion (HP) was started 4.5 h after admission at a flow of 250 mL/min for 4 h. Clearance over the resin column was 136 mL/min. Although the patient rapidly improved, a total of no more than 200 mg (2%) was removed. Total body clearance of chloroquine was increased by only 5% during HP. Treatment should therefore be directed toward aggressive supportive therapy rather than techniques to increase elimination.

Chloroquine↗
PubMed1981

Effects of prolonged anesthesia with enflurane or halothane on renal function in dogs.

Elevated serum inorganic fluoride levels (60-300 mumol/l), maintained over 6 h, influenced renal function in beagle dogs. Changes in water reabsorption were seen with an increased urine flow and free water clearance and decreased urinary concentration capacity. Possible nephrotoxicity as an effect of inorganic fluoride production during prolonged enflurane anesthesia was evaluated in a group of beagle dogs. Another group of dogs, anesthetized with halothane in equianesthetic doses, was studied for comparison. Serum inorganic fluoride levels and urinary oxalate excretion were determined and postanesthetic renal morphology was examined. Renal function was evaluated from endogenous clearances and concentration capacity before and after anesthesia. In the enflurane group, serum inorganic fluoride levels peaked at 22.5 mumol/l at the end of anesthesia and decreased rapidly in the postanesthetic period. Urinary oxalate excretion did not increase. No changes in renal morphology were found. Renal function tests did not reveal any disturbance after enflurane anesthesia. The two anesthetized groups did not differ in any of the parameters studied, except in serum inorganic fluoride levels.

Animals↗
PubMed1981

Effects of renal function on serum fluoride level in dogs during and after enflurane anesthesia.

To study the effect of renal function on the increased serum inorganic fluoride level produced by the metabolism of enflurane, three groups of beagle dogs were exposed to prolonged enflurane anesthesia, 1.25 MAC for 8 h. One group was studied both with and without renal function, one group only without renal function, and one group on two different occasions with renal function intact. Serum inorganic fluoride levels were determined every hour during the enflurane anesthesia and on termination for a further 4 h. In dogs with no renal function, the increase rate and the peak of serum inorganic fluoride level were significantly higher than in dogs with renal function. The average peak level in dogs with renal function was 21.4 mumol/l and in dogs with no renal function 38.4 mumol/l. Renal function was found to have the same capacity to increase the inorganic fluoride elimination from serum as other routes of elimination. At corresponding serum levels, the rate of decrease after terminating enflurane anesthesia was 3.5-4.0 mumol/l/h lower without renal function. Reanesthesia after 3 weeks did not significantly change the serum inorganic fluoride levels compared to the first anesthesia.

Anesthesia, General↗
PubMed1981

Enflurane anesthesia in living donor renal transplantation.

Two groups of patients undergoing elective living donor renal transplantation were studied during enflurane or halothane supplemented anesthesia. The duration of anesthesia was similar in both groups. The mean administered enflurane dose was 243 vol % min; the corresponding halothane dose was 56 vol % min. In the enflurane group, the mean serum inorganic fluoride level peaked at 21.0 mumol/l 3 h after the end of anesthesia. The inorganic fluoride level in urine produced by the renal graft increased continuously, but did not peak, during the first 24 postanesthetic hours. The renal graft quickly started to function in all patients in both groups. The frequency of rejection reactions was higher in the enflurane group than in the halothane group. Serum creatinine levels decreased rapidly in both groups. Urine flow was high on the day of transplantation, but normalized on the first postanesthetic day. Renal sodium clearance decreased earlier in the enflurane group than in the halothane group. This difference was statistically significant on the first postanesthetic day. In the enflurane group, the required pancuronium dose was significantly lower than in the halothane group. In one patient in the enflurane group, the serum inorganic fluoride level increased to 37.5 mumol/l. In this patient renal tubular function may have been affected, but the change was not conclusive since a pronounced rejection of the graft became evident. Since increases in serum inorganic fluoride level approaching 75% of the threshold level for nephrotoxicity in normal kidneys may occur, enflurane should not be routinely used in anesthesia for renal transplantation.

Anesthesia, General↗
PubMed1980

Hemoperfusion with Amberlite resin in the treatment of self-poisoning.

Ten patients with various intoxications were treated with resin hemoperfusion. Three of four patients with grade IV coma due to tricyclic antidepressant (TCA) poisoning could be extubated during or on termination of hemoperfusion. Clearance values of 135--185 and 190--200 ml/min were obtained for amitriptyline and nortriptyline, respectively. One patient with severe chloral hydrate poisoning could be extubated after less than one hour's hemoperfusion. A clearance of 140 ml/min was obtained in a uremic patient with AV block II due to digitoxin intoxication. Four patients with mushroom poisoning were treated with combined hemoperfusion-hemodialysis. A transient fall in platelet count was seen in all patients. Resin hemoperfusion is of definite value in selected, severe cases of self-poisoning with psychotropic drugs such as TCA and possibly in cases of mushroom poisoning where the prognosis with hemodialysis and supportive therapy is doubtful.

Adult↗
PubMed1980

Anesthesia for cesarean section.--VI Late effects on the infant of enflurane anesthesia for cesarean section.

Enflurane anesthesia for cesarean section has given favourable results with regard to anesthetic effect and lack of depression of the neonate. Enflurane is metabolized to fluoride. High serum levels of inorganic fluoride are nephrotoxic. The nephrotoxic level is known for healthy adult kidneys but not for neonatal kidneys. In a study on enflurane anesthesia for cesarean section serum analyses revealed increased inorganic fluoride levels in the neonates. To exclude unwanted effects on the children, a follow-up study was undertaken 6-12 months after delivery. General development and renal function were studied. No abnormalities were found, indicating that enflurane anesthesia for cesarean section has no persistent unfavourable effects on the children.

Anesthesia, Inhalation↗
PubMed1980

Anesthesia for cesarean section--VII. Early effects on neonatal renal function of enflurane anesthesia for cesarean section.

Fourteen women undergoing elective cesarean section were anesthetized with enflurane for induction and maintenance of anesthesia. Blood enflurane and serum inorganic fluoride levels were studied in the mothers at delivery and in the neonates at delivery and in the early neonatal period. Also neonatal urinary excretion of inorganic fluoride was determined. Renal function of the neonates was tested with a sodium load at the age of 1 day. Enflurane showed the expected distribution between mothers and neonates. The enflurane level of the neonates declined rapidly after delivery. Serum inorganic fluoride level increased significantly in the mothers from start of anesthesia until delivery. The neonatal level was lower and did not reach the level of neonates in areas with a high natural fluoride content in drinking water. The level of inorganic fluoride in urine was higher than the corresponding serum level, indicating an inorganic fluoride concentrating effect of the neonatal kidney. The difference between urinary excretion and serum content of inorganic fluoride showed neonatal metabolism of enflurane. The urinary sodium excretion did not differ from that of infants delivered without halogenated inhalation agents given to the mothers.

Anesthesia, Inhalation↗
PubMed1979

Effects of enflurane anesthesia on the function of ischemically damaged kidneys.

Enflurane is metabolized to inorganic fluoride. Serum levels of inorganic fluoride exceeding 50 microM/l are considered nephrotoxic for normal kidneys. Renal damage has not been observed after enflurane anesthesia in patients with normal renal function. Further impairment in patients with previously damaged kidneys has been reported. The restitution of function of ischemically damaged kidneys was studied in two groups of dogs. In one of the groups, dogs were submitted to a long duration enflurane anesthesia. The other group served as a control. In the first group the serum level of inorganic fluoride at the end of the anesthesia was 27.9 microM/l. Renal function was studied with endogenous clearances and concentration capacity. The inorganic fluoride level achieved by enflurane anesthesia did not influence the restitution of renal function.

Anesthesia, Inhalation↗
PubMed1977

Ebstein's anomaly--anaesthetic problems. A case report.

A patient with Ebstein's anomaly undergoing anaesthesia for the operation of hysterectomy is reported. The considerations relating to the risk of an increased right-to-left intracardiac shunt are discussed. The patient was anaesthetized successfully with a combination of nitrous oxide, droperidol and fentanyl.

Adult↗
PubMed1976

Anesthesia for cesarean section V: effects of enflurane anesthesia on the respiratory adaptation of the newborn in elective cesarean section.

The new anesthetic inhalation agent, enflurane, is supposed to allow rapid induction and recovery. Experinece with this agent in obstetrics is limited. Enflurane was therefore studied in 14 pregnant women undergoing elective cesarean section. Its effects upon the respiratory adaptation of the newborn infants were followed during the first 3 hours, as judged by oxygen tensions and acid-base balance measurements in serial neonatal arterial samples. Results were compared with those from a previously studied group of women anesthetized with a barbiturate and nitrous oxide-oxygen. There were no differences with respect to oxygen tension. Carbon dioxide values in the enflurane group were higher than those in the barbiturate group. In comparison with the barbiturate group the enflurane group of babies had lower BD values, which is a sign of a better metabolic state post-partum. Mothers anesthetized with enflurane were satisfied with the method, especially for the post-operative period.

Adaptation, Physiological↗
PubMedDate not supplied

Is it possible to evaluate the efficacy of amino acid solutions after major surgical procedures or accidental injuries? Evaluation in a randomized and prospective study.

Two unbalanced amino acid solutions (essential amino acids, branched-chain amino acids) were compared to a complete and balanced amino acid solution with regard to efficacy of nitrogen balance. Patients were randomized to receive the amino acid solutions over 3 days for each regimen. The patients were examined postoperatively or directly after accidental trauma. Nonprotein calories were given as 40 kcal/kg/day consisting of 50% fat and 50% glucose. Nitrogen was given at the amount of 0.15 g N/kg/day. Unbalanced amino acid solutions gave a 2-fold more negative nitrogen balance than a balanced and complete amino acid solution. However, this difference disappeared and nitrogen balance approached equilibrium irrespective of the amino acid composition of the infused solutions when nitrogen in blood products was accounted for. All patients received a considerable amount of blood products in a comparable but unpredictable way. Blood products corresponded to around 40% of the daily nitrogen intake. Our study demonstrates that it is not possible to test the efficacy of amino acids for nitrogen retention in patients who are in the need of blood-product transfusions. It is likely that amino acids in blood proteins serve as a significant amino acid source that is utilized for resynthesis of body proteins especially in flow-phase patients with high protein breakdown. This fact has not been sufficiently accounted for in the previous literature.

Adult↗