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J Wallenborn

Publications and source records attributed to J Wallenborn.

5 recordsLinked to original sources
PubMed2005

Movement of the upper cervical spine during laryngoscopy: a comparison of the Bonfils intubation fibrescope and the Macintosh laryngoscope.

The movements of the upper cervical spine were measured by fluoroscopy in 20 patients during laryngoscopy with the Bonfils intubation fibrescope and the Macintosh laryngoscope. Laryngoscopy with both the Bonfils intubation fibrescope and the Macintosh laryngoscope resulted in significant extension of the cervical spine as compared to the neutral position but this extension was significantly less with the Bonfils intubation fibrescope than with the Macintosh (p = 0.001). However, the atlanto-occipital distance was significantly greater during laryngoscopy with the Bonfils intubation fibrescope (p = 0.002), and the angle between the occiput and C1 differed significantly between the two techniques (p = 0.001). With the Bonfils intubation fibrescope, significantly less extension was also found at the C1/C2 and C3/C4 levels (p = 0.001 and p = 0.049, respectively). There is therefore significantly less movement of the upper cervical spine during laryngoscopy with the Bonfils fibrescope compared with the Macintosh laryngoscope.

Adult↗
PubMed2003

[Metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting after inhalational anaesthesia].

OBJECTIVE: Because of its complex profile of action (binding to dopamine, serotonin and histamine receptors), low rate of adverse effects and low cost as a medicinal preparation, metoclopramide is an interesting substance for the prophylaxis of post-operative nausea and vomiting (PONV). As a single substance its antiemetic effects are slight at the usual dose, so the aim was to test the efficacy of a combination of metoclopramide and dexamethasone for the prevention of PONV on a group of patients with the same operative trauma. METHOD: All patients (n = 204) were recruited prospectively (January-October 2002) and were to undergo a lumbar disc operation. The anaesthetic was administered according to a standard procedure as a balanced anaesthetic with fentanyl and isoflurane in oxygen/air. 60 min before the end of the operation, all patients were given 10 mg of metoclopramide and 8 mg of dexamethasone intravenously. The Würzburg-Oulu-Score served as an instrument for comparison, because no placebo group has been included. 24 hours after the operation, all patients were asked to report on nausea and vomiting, stating the time and the degree of discomfort (quantification by means of an analogue numerical scale from 0-10). The influence of age, height, weight, duration of the anaesthetic, operating position and increased dexamethasone dose was analyzed in addition to the risk factors according to the score. The cost analysis was based on the purchase prices of the hospital dispensary. RESULTS: The expected PONV incidence was 35.8%; 10% nausea (average intensity 4.3) and 3% emesis (4.8) was reported for the 24-hour period. The rescue medication (dimenhydrinate) was requested 8 times. Nausea was mainly during the early part of the period (0-6 hours). Of 42 patients with a history of PONV, 71% had no symptoms. The Odds Ratios for female sex (2.9), non-smoker status (2.0) and post-operative opioid administration (1.9) correspond to the data given in the literature; it was not possible to determine the significance of a history of PONV as an independent risk factor. None of the other factors investigated had a significant influence on PONV. For the chosen combination of antiemetic drugs the number-needed-to-treat is 3.9 (95% CI: 3.3-4.7). The direct costs of the PONV prophylaxis are 0.65 euro per patient. CONCLUSIONS: The metoclopramide/dexamethasone combination proved to be effective and inexpensive, on the basis of these findings it is used prophylactically at our hospital if only one PONV risk factor exists.

Adjuvants, Anesthesia↗
PubMed2002

[Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording--a case report].

Central venous catheters (CVCs) can be associated with various complications which arise during insertion, with the catheter in situ or upon its removal. Here we report a case of secondary CVC malposition that occurred despite checks of CVC position by different methods. A subclavian triple-lumen catheter was retracted until intra-atrial ECG indicated reversal to a normal P-wave. Blood was successfully aspirated through all three lumens, and the catheter was fixed at 11 centimeters intracorporal length and used intraoperatively. A postoperative chest X-ray demonstrated an intravenous CVC length of only a few centimeters, which was accepted because of the inconspicuous results of previous monitoring. Fifteen hours after CVC insertion, the patient developed a swelling in the subclavian and right neck region, a pronounced hydromediastinum and small bilateral pleural effusions caused by paravenous infusion through the most proximal CVC lumen. After instantaneous removal of the catheter, the patient recovered without further complications. This case demonstrates that even carefully-fixed multi-lumen catheters can partially dislocate due to a patient's movements or changes of position. Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary CVC malposition. Moreover, repeated chest radiographs are useful in verifying a correct CVC position and detecting late complications. In summary, CVC complications can occur with delay, are potentially life-threatening and may necessitate repeated checks of catheter position. This case report discusses different approaches to detecting malposition and reviews rare CVC complications.

Aged↗