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J Motsch

Publications and source records attributed to J Motsch.

At least 19 recordsLinked to original sources
PubMed1998

Inhaled nitric oxide inhibits human platelet aggregation, P-selectin expression, and fibrinogen binding in vitro and in vivo.

BACKGROUND: Recent data suggest that inhaled NO can inhibit platelet aggregation. This study investigates whether inhaled NO affects the expression level and avidity of platelet membrane receptors that mediate platelet adhesion and aggregation. METHODS AND RESULTS: In 30 healthy volunteers, platelet-rich plasma was incubated with an air/5% CO2 mixture containing 0, 100, 450, and 884 ppm inhaled NO. ADP- and collagen-induced platelet aggregation, the membrane expression of P-selectin, and the binding of fibrinogen to the platelet glycoprotein (GP) IIb/IIIa receptor were determined before (t0) and during the 240 minutes of incubation. In addition, eight patients suffering from severe adult respiratory distress syndrome (ARDS) were investigated before and 120 minutes after the beginning of administration of 10 ppm inhaled NO. In vitro, NO led to a dose-dependent inhibition of both ADP-induced (3+/-3% at 884 ppm versus 70+/-6% at 0 ppm after 240 minutes; P<.001) and collagen-induced (13+/-5% versus 62+/-5%; P<.01) platelet aggregation. Furthermore, P-selectin expression (36+/-7% of t0 value; P<.01) and fibrinogen binding (33+/-11%; P<.01) were inhibited. In patients with ARDS, after two who did not respond to NO inhalation with an improvement in oxygenation had been excluded, an increase in plasma cGMP, prolongation of in vitro bleeding time, and inhibition of platelet aggregation and P-selectin expression were observed, and fibrinogen binding was also inhibited (19+/-7% versus 30+/-8%; P<.05). CONCLUSIONS: NO-dependent inhibition of platelet aggregation may be caused by a decrease in fibrinogen binding to the platelet GP IIb/IIIa receptor.

Administration, Inhalation↗
PubMed1998

Interruption of bronchial circulation leads to a severe decrease in peribronchial oxygen tension in standard lung transplantation technique.

OBJECTIVE: In clinical practice lung transplantation is the only procedure where the transplanted organ is left without its own arterial perfusion. With the interruption of the bronchial arteries the nutritive support is dependent on collateral flow by the pulmonary artery and the oxygen tension of desaturated central venous blood, representing an abnormal physiology. METHODS: To analyze this problem systematically, we used a standard single left lung transplantation model in the pig (n = 12). In accordance with the clinical standard, lung preservation was performed with modified Euro-Collins solution with addition of prostacycline. The duration of ischemia was set to 4 h. Before and after single left lung transplantation tissue oxygen tension in the peribronchial tissue was measured with Licox tissue pO2 microprobes. For validation, the myocardial tissue oxygen tension was recorded simultaneously. The hemodynamic assessment included continuous flow measurement of the left and right pulmonary artery using Transsonic ultrasound flow probes. After transplantation the animals were observed for 4 h. For hypothetic augmentation of collateral blood flow to the peribronchial tissue we administered Nitric oxide (10 ppm) to the ventilation in six pigs (group B). Six pigs (group A) served as a control without the addition of nitric oxide (NO). All pigs were ventilated with a FiO2 of 0.5 resulting in paO2 values between 160 and 200 mmHg. RESULTS: In both groups single lung transplantation led to a significant decrease in peribronchial tissue oxygen tension throughout the observation period. Pre-Tx values of peribronchial tissue oxygen tension (38.31 +/- 6.56 mmHg) decreased to 9.72 +/- 2.55 mmHg in group A and 10.3 +/- 3.61 mmHg in group B after 4 h, which could not be altered by a FiO2 of 1.0 (P < 0.0001). The addition of NO in group B led to a significantly augmented flow in the left pulmonary artery (0.63 +/- 0.31 l/min in group B vs. 0.46 +/- 0.26 l/min group A, P < 0.001) representing 67 vs. 49% of the pre-Tx flow in groups B and A, respectively, but the peribronchial tissue oxygen tension was not influenced (P > 0.05). In both groups A and B, the central venous pO2 did not differ in the postoperative period (41.83 +/- 3.27 mmHg group A vs. 43.26 +/- 2.98 mmHg group B) and was kept in a comparable range to the pretransplantation values (45.23 +/- 3.41 mmHg pre-Tx). CONCLUSIONS: The persistence of a very low peribronchial tissue oxygen tension in the early phase after lung transplantation cannot be influenced by improved pulmonary artery flow and solely relates to the central venous pO2, which cannot be augmented by the addition of NO. This mechanism might be a trigger for anastomotic healing problems, infectious complications and later development of obliterative bronchiolitis (OB).

Animals↗
PubMed1998

[Economic aspects of anesthesia. II. Cost control in clinical anesthesia].

The primary scope of economic analyses is the quantification of the costs (input) in relation to the results (outcome, output). According to whether a similar or different dimension of outcome parameters is chosen, it is possible to differentiate between cost minimisation, cost effectiveness, cost benefit and cost utility analyses. Decision trees and sensitivity analyses serve to develop or examine cost outcome studies. The principal perspective of economic analysis is of crucial significance. In the present overview of cost control programmes in clinical anaesthesia, the perspective chosen throughout is that of budget responsibility in a department of anaesthesiology. With regard to economic factors in clinical anaesthesiology, the cost of medical and nursing staff represents the largest cost block. It is, therefore, essential that personnel is efficiently employed, i.e. how the perioperative procedure is organised. In the area of material costs, blood products--including coagulation factors and plasma substitutes--are particularly cost intensive, followed by medical products and drugs, especially muscle relaxants and inhalational anaesthetics. In the perioperative context, the costs of anaesthesia personnel account for 5-15% of the total costs of patient care, while material costs account for 2-10%. In view of this small portion of the total costs, cost control programmes in anaesthesia can only make a relatively small contribution to reducing overall cost. However, it must be realised that anaesthesia care is vitally important for the perioperative process which means that in this context cost-effectiveness interventions have consequences that also affect other fields, e.g. postoperative pain service besides anaesthesia. In conducting economic analyses, cost considerations or reductions cannot be targeted alone, but must always also integrate outcome aspects so that costs and quality are regarded in relation to one another.

Anesthesia↗
PubMed1998

[Desflurane versus isoflurane in geriatric patients. A comparison of psychomotor and postoperative well-being following abdominal surgical procedures].

PURPOSE: The new volatile anaesthetic agent desflurane has a significantly lower blood-gas partition coefficient (0.42) than isoflurane (1.4), suggesting excellent intraoperative control of anaesthesia and rapid emergence and recovery from anaesthesia. However, only limited experience is available in geriatric patients undergoing major abdominal surgery. METHODS: After approval by the local ethics committee and with written informed consent, 52 patients (> or = 65 years old, ASA class II or III) scheduled for major abdominal surgery were randomised to receive either desflurane (DES) or isoflurane (ISO) for maintenance of anaesthesia. After oral premedication with midazolam 3.75-7.5 mg, anaesthesia was induced with etomidate 0.2-0.3 mg/kg and fentanyl 3 micrograms/kg. Vecuronium 0.1 mg/kg provided muscle relaxation for endotracheal intubation. All patients were mechanically ventilated to maintain normocapnia. For maintenance of anaesthesia, DES or ISO was administered in 60% N2O and additional boluses of fentanyl and vecuronium were given as required. At the end of surgery, the neuromuscular blockade was reversed with neostigmine 0.02 mg/kg and DES or ISO was discontinued at the end of skin closure. Episodes of bradycardia and tachycardia and hypo- and hypertension, the time from the end of anaesthesia to extubation, opening eyes, squeezing hand, stating name and birthdate and to discharge from the recovery room were recorded. Until 360 minutes after the end of anaesthesia, the recovery of psychomotor functions was measured by means of simple reaction time tests, critical flicker fusion test, labyrinth test, ball bearing test, short and long-term memory test and digit symbol substitution test. The patient's well-being was documented with scores for pain, sedation and postoperative nausea and vomiting. RESULTS: Demographic data in both groups was similar (Tab. 1). Anaesthesia was significantly prolonged in the ISO group. No significant differences between groups were found for MAC hours and the total dose of fentanyl and vecuronium administered (Tab. 3). Intraoperative haemodynamics were comparable between both groups (Tab. 4). No episodes of increases in heart rate or blood pressure associated with rapid increases in DES concentration were seen. Early emergence parameters were faster in the DES group (Tab. 5). When compared to ISO, the overall test performance and testing ability was superior following DES. Psychomotor tests showed significantly better results up to 240 minutes after the end of DES anaesthesia (Tab. 7, Fig. 4). Comparing the postoperative well-being, there were mild advantages for DES (Tab. 6, Fig. 1, 2, 3). However, time to discharge of geriatric patients from the recovery room was significantly shorter in the DES group (median 171 vs. 215 min., p < 0.05). CONCLUSION: Using a balanced anaesthesia technique, we found desflurane as suitable as isoflurane for geriatric patients. Additionally, due to the fast emergence from anaesthesia, an improved cooperativity was found. In the DES group overall better postoperative psychomotor performance resulted in a shortening of discharge times from the recovery room. Hence, desflurane anaesthesia may be advantageous in geriatric patients.

Abdomen↗
PubMed1998

Effects of preinduction and intraoperative warming during major laparotomy.

We have investigated the influence of active warming before and during operation on blood loss, transfusion requirements, duration of stay in the post-anaesthesia care unit (PACU) and perioperative costs in 40 patients undergoing major abdominal surgery. Patients were allocated randomly to one of two groups: in the study group (n = 20), patients were actively warmed using forced air for 30 min before induction of general anaesthesia and during anaesthesia. Passive protection against heat loss consisted of circulating water mattresses, blankets and fluid warming devices, and was used both in the active warming group and in the control group (n = 20). At the end of surgery the change in core temperature was significantly less in the group of actively warmed patients (0.5 (SD 0.8) degree C vs 1.5 (0.8) degree C; P < or = 0.01). Blood loss and transfusion requirements were less in the actively warmed patients, who had a shorter duration of stay in the PACU (94 (SD 42) min vs 217 (169) min; P < or = 0.01) and a 24% reduction in total anaesthetic costs.

Adult↗
PubMed1997

Epidural abscess after combined spinal-epidural block.

PURPOSE: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may constitute an additional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present. CLINICAL FEATURES: The combination of a spinal and a continuous epidural block (CSE) using a needle through needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb. On the fourth postoperative day the patient demonstrated back pain, fever, and exudation of pus from the CSE-puncture site. An epidural abscess was diagnosed by magnetic resonance imaging and subsequently an emergency hemiaminectomy was performed. Physical examination and surgery did not show evidence of bacterial spread into the subarachnoid space. CONCLUSION: Epidural abscess formation after CSE may increase the risk of bacterial spread into the subarachnoid space. In this case spontaneous exudation and surgical drainage of abscess material may have prevented intrathecal infection. Rapid diagnosis and treatment of an epidural abscess appears particularly essential after CSE to prevent neurological sequelae.

Abscess↗
PubMed1997

[Economic aspects of modern inhalation anesthetics with sevoflurane as an example].

The economic impact of the new German health care laws requires an awareness of cost-effectiveness when using newer drugs. The main goal in patient care, i.e., effective treatment, must be achieved by the rational use of restricted resources at a maximum degree of effectiveness. Economic aspects of the new inhalational anaesthetics such as sevoflurane are discussed in this article. The cost of inhalational anaesthetic agents accounts for up to 5% of all the running expenses of an anaesthesia department. The consumption and cost of an inhalational agent depend on fresh gas flow, vapour setting, and duration of anaesthesia. Comparing the cost for 1 MAC-h of anaesthesia, desflurane is more expensive at current market prices than sevoflurane and isoflurane. However, at low or minimal fresh gas flows, the price for one MAC-h is almost the same for these volatile anaesthetics. Total intravenous anaesthesia using propofol is even more expensive, partly due to wastage, i.e., opened ampoules with a remainder of propofol that has to be discarded after each case. When choosing an anaesthetic agent, the price of 1 ml liquid anaesthetic is an important factor. However, the overall cost-effectiveness analysis must balance the cost of the agent with its pharmacodynamic advantages such as more rapid recovery from anaesthesia. Furthermore, the indirect costs of side effects have to be taken into account. For example, nausea and vomiting lead to a prolonged stay in the recovery room after anaesthesia for outpatient surgery, which in turn incurs additional costs for antiemetic drugs and the extra time for nursing care. Therefore, a lower incidence of nausea and vomiting and a more rapid recovery from anaesthesia leading to earlier discharge from the recovery room may compensate for the higher price. Volatile agents account for up to 1% of the total intraoperative costs. In analysing the costs of 1 h of anaesthesia, other products such as plasma substitutes and blood products account for a much higher proportion than anaesthetic agents, and reductions or increases in costs pertaining to these products have a bigger impact on overall costs than do volatile anaesthetics. We conclude that volatile anaesthetics account for only a minor portion of the anaesthesia department budget and the cost of anaesthesia delivery. The higher market price of the new agents may be compensated for by the economic impact of fewer side effects and a shorter post-anaesthesia stay in the hospital. In analysing data for sevoflurane, this agent may be cost-effective, for example, for outpatient anaesthesia.

Anesthesia Department, Hospital↗
PubMed1997

The cerebral 'no-reflow' phenomenon after cardiac arrest in rats--influence of low-flow reperfusion.

OBJECTIVE: Experimental data indicate that early microcirculatory reperfusion is disturbed after cardiac arrest. We investigated the influence of prolonged cardiac arrest and basic life support (BLS) procedures on the quality of cerebral microcirculatory reperfusion. MATERIALS AND METHODS: In mechanically ventilated male Wistar rats anesthetized with N2O and halothane, cardiac arrest was induced by electrical fibrillation. Ten animals (group I) were subjected to 17 min of cardiac arrest (no-flow). Nine additional animals (group II) underwent only 12 min of cardiac arrest (no-flow), which was followed by a 5-min phase of BLS (i.e. mechanical ventilation and external cardiac compressions). In both groups, advanced resuscitation procedures including mechanical ventilation, external cardiac massage, 0.2 mg kg-1 epinephrine, 0.5 mmol kg-1 NaHCO3, and defibrillation were started 17 min after induction of cardiac arrest. The perfusion of the cerebral microcirculation was visualized by injection of 0.3 g kg-1 15% fluorescein isothiocyanate (FITC)-albumin 5 min after restoration of spontaneous circulation (ROSC), and the animals were decapitated 2 min later. The left hemispheres were fixed in 4% formalin, and coronal sections of 200 microns thickness at three different standard levels of the rat brain were investigated using fluorescence microscopy. Areas without capillary filling (cerebral 'no-reflow') were identified and calculated. RESULTS: ROSC could be achieved in five of 10 animals (50%) of group I, and in six of nine animals (67%) of group II (P = n.s.). The severity of cerebral 'no-reflow' was higher in group II compared with group I (6.9 +/- 7.6 vs. 0.7 +/- 0.7% of total sectional areas; P < or = 0.05). Two sham-operated animals showed homogeneous reperfusion. CONCLUSIONS: Wistar rats did not develop a marked cerebral 'no-reflow' phenomenon after circulatory arrest. A relevant degree of cerebral 'no-reflow' occurred, however, in animals subjected to a phase of BLS before circulatory stabilization. Therefore, low-flow states following prolonged cardiocirculatory arrest may aggravate early cerebral microcirculatory reperfusion disorders.

Animals↗
PubMed1997

Changes in intrathoracic fluid volumes during weaning from mechanical ventilation in patients after coronary artery bypass grafting.

PURPOSE: Although it is known that weaning from mechanical ventilation is associated with alterations in intrathoracic pressure, lung volume, and venous return, changes in intrathoracic fluid volumes during weaning are not reported. Especially in patients with impaired cardiac function, the development of pulmonary edema during weaning has been described. Thus, we investigated changes in intrathoracic fluid volumes in patients after coronary artery bypass grafting after changing the ventilatory pattern from mechanical to spontaneous ventilation. MATERIALS AND METHODS: Intrathoracic blood volume index (ITBVI), pulmonary blood volume index (PBVI), and extravascular lung water (EVLW) were calculated during mechanical ventilation (T1), T-piece breathing (T2), and spontaneous breathing after extubation of the trachea (T3) in 72 consecutive patients after coronary artery bypass grafting using a combined dye-thermal dilution method. RESULTS: Changing from mechanical ventilation to T-piece breathing resulted in an increase in ITBVI from 880 +/- 22 mL/m2 to 970 +/- 22 mL/m2 (P < .01), and in PBVI from 162 +/- 6 mL/m2 to 173 +/- 6 mL/m2 (P < .01). After extubation of the trachea, both parameters decreased again (ITBVI, 879 +/- 20 mL/m2; PBVI, 160 +/- 7 mL/m2). EVLW remained unchanged after transition to T-piece breathing (T1, 5.8 +/- 0.3 mL/kg; T2, 6.0 +/- 0.3 mL/kg), but increased to 6.6 +/- 0.5 mL/kg (P < .01) after extubation of the trachea. However, pathological values of EVLW were not observed. CONCLUSIONS: In patients after coronary artery bypass grafting, changes in intrathoracic intravascular fluid volumes during weaning are restricted to the period of T-piece breathing and reflect an increased venous return. The maintenance of EVLW in the normal range during weaning indicates that cardiac function was matched to this elevated preload.

Blood Volume↗
PubMed1997

Gastric intramucosal pH: a predictor of survival in cardiac surgery patients with low cardiac output?

OBJECTIVE: To assess the value of gastric intramucosal pH measurement in patients with low output after cardiac surgery. DESIGN: Prospective clinical study. SETTING: University hospital. PARTICIPANTS: Fifteen patients with low output after cardiac surgery were included. Those who survived the first postoperative day (n = 14) remained in the study. INTERVENTIONS: Gastric intramucosal pH and arterial lactate concentrations were measured 6, 12, and 24 hours after admission to the intensive care unit. Intravenous infusion of buffer solutions was strictly avoided during the equilibration period and in the half hour before injection of saline into the gastric balloon of the tonometer. MEASUREMENTS AND MAIN RESULTS: Eight patients survived during the 28-day observation period, and six patients died. On admission to the intensive care unit, no difference in cardiac index (1.56 v 1.54 L/min/m2) or pulmonary capillary wedge pressure (17.3 v 17.7 mmHg) was found between survivors and nonsurvivors. During the first 24 hours after surgery, arterial lactate was significantly higher in the nonsurvivor group (61 v 23 mg/dL), but there was no difference between the gastric intramucosal pH of survivors and nonsurvivors (7.41 v 7.42 on admission). CONCLUSIONS: Calculated gastric mucosal pH is not an early predictor of survival in cardiac surgery patients with postoperative low cardiac output syndrome. Further studies are required to assess whether the gradient between arterial and intramucosal partial pressure of carbon dioxide (PCO2) might be a more useful predictive value.

Adult↗
PubMed1997

In-use contamination of propofol. A clinical study.

Reports about post-operative infections associated with the use of propofol prompted us to investigate the in-use contamination of lipid-formulated intravenous (i.v.) anaesthetics used for general anaesthesia or for sedation of intensive care patients in this department. The level and incidence of extrinsic contamination of propofol ('Diprivan') and of another intravenous anaesthetic, etomidate, formulated in lipid solution ('Etomidat-lipuro') was found to be low during two study periods. However, the need to observe strict aseptic precautions in handling these intravenous drugs must be emphasized.

Anesthetics, Intravenous↗
PubMed1997

Effects of carbon dioxide pneumoperitoneum in pigs with impaired pulmonary function.

The objective of our study was to investigate the possible adverse hemodynamic effects of a CO2 pneumoperitoneum in an experimental model in pigs with impaired pulmonary function. Thirteen animals were anesthetized with azaperon/ketamine and ventilated with 67% nitrous oxide in oxygen. By intravenous injection of dextran microspheres, a capillary pulmonary embolism was induced. After embolization, three animals served as controls (Group 1), five underwent open nephrectomy (Group 2), and five underwent laparoscopic nephrectomy (Group 3). Intra-abdominal pressure was kept constant at 15 mm Hg. At intervals, hemodynamic parameters were measured, and blood gas measurements were performed. Data were analyzed using a general linear model analysis of variance for differences between groups, and a paired t-test was applied for differences within groups from one condition to the next. The groupwise comparison revealed a significant rise of cardiac output in the laparoscopy group compared with the open nephrectomy group. No differences were noted for heart rate, systemic arterial pressure, central venous pressure, mean pulmonary arterial pressure, or pulmonary arterial wedge pressure. Impairment of pulmonary function caused no negative hemodynamic effect during laparoscopic nephrectomy.

Analysis of Variance↗
PubMed1997

Reduction in nitrogen dioxide concentration by soda lime preparations during simulated nitric oxide inhalation.

Nitrogen dioxide is formed during delivery of inhaled nitric oxide for the treatment of patients with pulmonary hypertension. Soda lime has been shown to absorb nitrogen dioxide. We tested three different commercially available soda lime preparations (Sodasorb, Drägersorb 800 and Sofnolime) for their efficacy in absorbing nitrogen dioxide and nitric oxide during simulated nitric oxide inhalation. All soda lime preparation absorbed nitrogen dioxide (15%, 24% and 34%, respectively). To test if this difference could be attributed to the potassium hydroxide (KOH) content of the different preparations, two other preparations with a higher (3.0% and 7.3% w/w, respectively) KOH content were tested and we found an increase in nitrogen dioxide removal up to 47% and 46%, respectively. We conclude that soda lime absorbed nitrogen dioxide during nitric oxide inhalation. This effect seemed to be moderate under simulated clinical conditions, but increased using soda lime with a higher KOH content. Nevertheless, we recommend continuous monitoring of inspired nitrogen dioxide concentration during clinical inhalation of nitric oxide.

Absorption↗
PubMed1997

Inhaled nitric oxide inhibits platelet aggregation after pulmonary embolism in pigs.

BACKGROUND: Inhaled nitric oxide (NO) is reported to prolong bleeding time in animals and humans and to inhibit platelet aggregation in persons with acute respiratory distress syndrome. In pulmonary embolism (PE), inhibition of platelet aggregation appears useful because further thrombus formation may lead to right ventricular dysfunction that results in circulatory failure. In the present study, the effect of inhaled NO on platelet aggregation after acute massive PE was investigated. METHODS: After acute massive PE was induced in 25 anesthetized pigs by injecting microspheres, 5, 20, 40, and 80 parts per million inhaled NO were administered stepwise for 10 min each in 11 animals (NO group). In the control group (n = 14). NO was not administered. Adenosine diphosphate-induced initial and maximal platelet aggregation were measured before PE (10), immediately after induction of PE (PE), at the end of each 10-min NO inhalation interval (t10-t40), and 15 min after cessation of NO inhalation (t55) in the NO group, and at corresponding times in the control group, respectively. RESULTS: Two animals in the control group and one in the NO group died within 10 min after PE induction and were excluded from analysis. Peaking at t40 and t55, respectively, initial (-13 +/- 6%; P < 0.05) and maximal (+44 +/- 17%; P < 0.05) platelet aggregation increased significantly after PE in the control group. In contrast, NO administration after PE led to a significant decrease in initial (maximum decrease, -9 +/- 3% at t40; P < 0.05) and maximal (maximum decrease, -15 +/- 7% at t30; P < 0.05) platelet aggregation. In the NO group, platelet aggregation had returned to baseline levels again at t55. In addition, NO administration significantly decreased mean pulmonary artery pressure and significantly increased end-tidal carbon dioxide concentration and mean systemic blood pressure. CONCLUSIONS: Inhaled NO has a systemic and rapidly reversible inhibitory effect on platelet aggregation after acute massive PE in pigs. This may be beneficial in treating acute massive PE.

Administration, Inhalation↗
PubMed1997

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation.

We evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.8-18.9 l.min-1, continuous cardiac output range: 3.3-20.0 l.min-1). During most of the procedure the correlation between intermittent and continuous cardiac output measurements was significant (r = 0.87, p < 0.0001), accompanied with a bias of -0.240 l.min-1 and a degree of precision of 1.789 l.min-1 (< 10.0 l.min-1:1.137 l.min-1, > or = 10.0 l.min-1:2.220 l.min-1). However, in the early phases after caval clamping and after reperfusion, accuracy was not acceptable. Only during these phases did the difference between the mean values of pulmonary artery blood temperature and rectal temperature increase (after caval clamping) or decrease (after reperfusion). In conclusion, despite acceptable levels of accuracy and precision between intermittent and continuous cardiac output measurement under stable conditions, both methods showed markedly decreased accuracy and precision in the early phases after caval clamping and after reperfusion, possibly owing to increased thermal noise.

Adult↗
PubMed1997

Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children.

BACKGROUND: Clonidine produces analgesia by actions on alpha 2-adrenoceptors and enhances both sensory and motor blockade from epidural injection of local anaesthetics. Low-dose clonidine has been used so far for caudal injection in children. Our aim was to study the perioperative effects of high-dose caudal clonidine when added to low concentration of bupivacaine for combined epidural and general anaesthesia in children. METHODS: After induction of general anaesthesia caudal block was performed either with 1 ml.kg-1 bupivacaine 0.175% with the addition of clonidine 5 micrograms.kg-1 (n = 20), or with 1 ml.kg-1 bupivacaine 0.175% (n = 20). The intraoperative anaesthetic requirements, the perioperative haemodynamic effects, respiratory rate, sedation score, postoperative pain scores and side effects were assessed by a blinded observer. A patient-controlled analgesia system was used for postoperative pain relief. The quality of postoperative pain relief was assessed using Smiley's pain analogue scale. RESULTS: Intraoperative haemodynamic responses did not differ between the groups. However, during emergence from general anaesthesia children in the clonidine group had significantly lower heart rates and blood pressure compared to children in the control group. In addition, heart rates and blood pressures were also lower in the clonidine group in the early postoperative period (P < 0.05). Postoperative analgesia was significantly better in the clonidine group as evidenced by the total number of requests (3 vs 12, P < 0.05) and the total amount of tramadol (20.5 mg vs 72.8 mg, P < 0.05) administered. The duration of the caudal analgesia was significantly longer in the clonidine group (20.9 +/- 7.4 h vs 14.4 +/- 10.9 h, P < 0.05). CONCLUSION: Our results suggest that caudal clonidine 5 micrograms.kg-1 enhances and prolongs caudal blockade with bupivacaine (1.175% in children. It also blocks sympathoadrenergic responses during emergence from anaesthesia. Sedation and cardiovascular effects are observed up to 3 h into the postoperative period.

Adrenergic alpha-Agonists↗
PubMed1996

Retention of the antibiotic teicoplanin on a hydromer-coated central venous catheter to prevent bacterial colonization in postoperative surgical patients.

OBJECTIVE: Antibiotic-coated intravascular catheters may be an effective means of decreasing bacterial colonization and subsequent catheter-related infection. The present study was designed to investigate the retention of the antibiotic teicoplanin on a hydromer-coated intravenous catheter and the effect of this antibiotic coating on catheter bacterial colonization. DESIGN: A prospective, randomized pilot study. SETTING: Operating rooms (ORs) and an intensive care unit (ICU) at a university hospital. PATIENTS: A consecutive group of 20 male patients undergoing major abdominal surgery. INTERVENTIONS: Control (C; n = 10) or teicoplanin-coated (T; n = 10) single-lumen central venous catheters were inserted before surgery in the OR. Catheters were withdrawn at the discretion of the physicians in the ICU after various periods. MEASUREMENTS: The teicoplanin content of the catheter material was assessed using a bioassay with Bacillus subtilis after complete elution of the antibiotic from the catheter. Bacterial colonization was measured using a quantitative culture technique after the catheter lumen had been flushed and the catheter segments sonicated. MAIN RESULTS: Nearly three-quarters of the initial teicoplanin coating (374 +/- 103 micrograms; mean +/- SD) were released during the first day of catheterization, and after 36 h of intravenous catheterization, no antibiotic was retained on the catheter. No significant difference could be found either in the incidence of bacterial colonization between test (n = 3) and control (n = 4) catheters or in the number of colony-forming units (CFU) on the catheter segments (T, 263 +/- 104 CFU/cm; C, 372 +/- 294 CFU/cm; mean +/- SEM). CONCLUSION: The retention of teicoplanin antibiotic coating on hydromer catheters is only short term if catheters are inserted intravenously. This may limit clinical antibacterial efficacy.

Anti-Bacterial Agents↗