Biomedical subjects

K Butscher

Publications and source records attributed to K Butscher.

3 recordsLinked to original sources

PubMed1996

[Chylothorax following closed thoracic injury].

Chylothorax following blunt chest trauma is a rare event. The presence of a cloudy or milky persistent pleural effusion should suggest the possibility of its chylous origin. The diagnosis is made by analysis of the fluid obtained either from thoracentesis or tube thoracostomy. A lymphangiogram can show the site of the lesion, but computed tomography is a more recent and probably as helpful diagnostic test. An efficient control of the chylous effusion may be facilitated by using a fat-poor enteral nutrition and parenteral nutrition, which prevents malnutrition. Surgical ligation of the thoracic duct is relatively simple and efficient. It is indicated when the daily chylous flow is over 500 mL after 2 or 3 weeks of medical treatment or in case of weight loss.

Adult↗

PubMed1996

[Effects of different loading solutions on plasma osmolality].

OBJECTIVE: As hydratation of the normal brain is much more dictated by osmotic gradients than by hydrostatic or oncotic pressures, this study aimed to compare the effect of the infusion of currently used volume loading solutions on plasma osmolality. STUDY DESIGN: Randomized, comparative trial. PATIENTS: Thirty ASA 1-2 patients, scheduled for lumbar intervertebral disc surgery were randomly allocated to three groups receiving either 2,000 mL of lactated Ringer's solution (RL, n = 10), 750 mL of hydroxyethylstarch 6% (HEA, n = 10) or 2,000 mL of normal saline (NaCl, n = 10). METHODS: Baseline osmolality, natraemia, glycaemia and protidaemia were measured before induction of anaesthesia (T1), after the infusion of 375 mL of hydroxyethylstarch or 1,000 mL of crystalloids (T2) and at the end of the infusion (T3). RESULTS: The three groups were identical for age, weight, initial plasma osmolality and natraemia. However, osmolality in the RL group was decreased at T2 and T3 compared to T1 (respectively: 299 +/- 5 mOsm.kg-1, 295 +/- 4 mOsm.kg-1 and 292 +/- 5 mOsm.kg-1. Osmolality at T2 and T3 was also lower in the RL group compared to the HEA and NaCl groups (respectively: 301 +/- 6 mOsm.kg-1 and 304 +/- 13 mOsm.kg-1 for T2 and T3 in the HEA group, and 299 +/- 5 mOsm.kg-1 and 298 +/- 5 mOsm.kg-1 in the NaCl group). In the HEA and NaCl groups, osmolality was unchanged at T2 and T3 compared to T1. CONCLUSION: Both normal saline and hydroxyethylstarch 6% maintain plasma osmolality, whereas Ringer lactate tends to decrease it. For that reason normal saline and hetastarch 6% but not lactated Ringer's solution, may be administered in patients experiencing blood-brain barrier damage.

Blood Glucose↗

PubMed1995

Can immediate opioid requirements in the post-anaesthesia care unit be used to determine analgesic requirements on the ward?

The aim of this prospective study was to evaluate the efficacy of two dosage regimens of (i.m.) morphine calculated from an initial (i.v.) titrated dose in the early postoperative period. Seventy ASA I-III patients who underwent general anaesthesia (GA) (n = 58), regional anaesthesia (RA) (n = 10) or GA+RA (n = 2) for orthopaedic (n = 54), urological (n = 11) or abdominal surgery (n = 5) received i.v. titrated morphine in the post-anaesthesia care unit (PACU). Titration consisted of 3 mg morphine i.v. every ten minutes until patients had a visual analogue pain scale (VAS) < 3, without marked sedation. Seventeen patients did not complain at all or had good analgesia with an initial i.v. dose < or = 6 mg of morphine followed by paracetamol only. Patients who needed more than 6 mg i.v.morphine were randomly assigned to a "high-dose" or a "low-dose" group and received a systematic i.m. morphine regimen calculated from the initial titrated dose. Pain was assessed by VAS before each i.m. injection and the next morning. One patient had respiratory depression and one marked sedation in the PACU. These patients were excluded from the rest of the study. Only 16 patients were excluded from the rest of the study. Only 16 patients had a VAS > 3 at least once during the study period and only three needed rescue analgesia which was available on request. We conclude that a systematic i.m. morphine regimen adapted from an initial i.v. titration in the PACU provides efficacious and relatively inexpensive postoperative analgesia, applicable to a great majority of patients.

Adolescent↗