[Topical administration of unfractionated and low molecular weight heparin for prevention of appositional thrombus formation].
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Administration, Topical↗
Biomedical subjects
K Erdmann
Publications and source records attributed to K Erdmann.
[The potentialities of EEG analysis using the Lifescan in anesthesiology].
In 87 patients a new computerized EEG monitor was used in clinical anesthesia. Following aperiodic analysis, the Lifescan shows the computerized EEG in a striking color visualization allowing recognition of changes in the course of the EEG and of interhemispheric differences. The computerized EEG can be read after a brief training period. The changes caused by different clinical situations are visualized in detail. Different changes were observed with the anesthetics used. During induction with thiopentone a sudden increase in activity was obvious. During a lighter level of anesthesia with thiopentone beta activity was easily recognizable. During induction with high-dose fentanyl frequency was slowed over a long period and activity was increased. The monitor shows the changes in the lower frequency range in detail. A bimodal pattern occurred with a higher dosage of enflurane. During lightening of anesthesia with enflurane a typical pattern indicated return to consciousness. When nitrous oxide was administered during anesthesia with halothane, and to a lesser degree during anesthesia with enflurane or isoflurane, remarkable slowing and decrease in activity occurred. The monitor allowed detailed recognition of the different patterns obtained with the various anesthetics. In some cases it was possible to say what dosage of the anesthetic used had been given or what depth of anesthesia had been achieved. The effect of combined anesthesia, however, was difficult to judge. In carotid artery surgery a quick unilateral decrease in activity and slowing of frequency indicated cerebral ischemia and quickly disappeared after insertion of a shunt. This change was particularly obvious with the new monitor.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
High spinal anesthesia does not depress central nervous system function as measured by central conduction time and somatosensory evoked potentials.
Short-latency somatosensory evoked potentials (SSEPs) in response to median nerve stimulation were recorded from the neck and the scalp before and during diagnostic high spinal anesthesia (touch T3, pinprick C8) in six patients with chronic pain. The central conduction time--the time difference between the neck-recorded N13 and the scalp-recorded N20--and the amplitudes of the SSEPs did not change in a statistically significant way during high spinal anesthesia. However, latencies of the neck-recorded N13 and the scalp-recorded N20 and P25 increased slightly. This may have been due to a local anesthetic effect on those spinal roots of the median nerve in which segmental pinprick analgesia occurred. Because high spinal anesthesia did not depress central nervous function, as measured by central conduction time, and SSEP amplitudes, it is concluded that scalp-recorded SSEPs during high spinal anesthesia measure the effects of local anesthetics in the cerebrospinal fluid on neuronal pathways outside the brain.
Adult↗
[Transpapillary endoprostheses in malignant and benign bile duct diseases].
During the last years the non-surgical drainage of the bile ducts developed to an efficient treatment method and is a real enrichment in the concept of treatment of the malignant obstruction of the bile ducts. In no more radically operable carcinomas in the area of the bile ducts, the pancreas or the porta of the liver it is to be preferred to a palliative drainage operation. In case the drainage of the bile ducts shall not be used therapeutically (through-drainage), an inner drainage in form of an endoprosthesis should always be preferred. As a procedure of the 1st choice the endoscopic retrograde technique is recommended, as procedure of 2nd choice the percutaneous transhepatic technique. Benign basic diseases are more infrequently the reason for the insert of a bile duct drainage. The main indications are general inoperability in non-extractable calculi in the common bile duct. In our own cases patients could be followed up up to 3.5 years. No complications were observed. The occlusion of prostheses does apparently not play a role.
Ampulla of Vater↗
[Clinical aspects, diagnosis and therapy of cancer of Vater's ampulla].
The carcinoma of the papilla occupies a special position among the periampullary carcinomas by its favourable prognosis. Responsible for this are the early appearance of symptoms due to the close neighbourhood to the common bile duct and the restriction of the metastasation to the first stage of lymphatic nodes in the majority of cases. Symptoms are jaundice, epigastric pain and decrease of weight. In the carcinoma of the papilla the duodenoscopy with biopsy and ERCP is the method of choice. The reliability of the biopsy is larger, when it is performed after an endoscopic sphincterotomy. For the delimitation of the carcinoma of the papilla against other causes can further be used the hypotensive duodenography, the abdominal computerd tomography, the sonography and the PTC. A curative treatment is possible only surgically. On account of the better long-term results the partial duodenopancreatectomy is to be preferred to the local exstirpation of the papilla. Endoscopic drainages of the biliary tract carried out preoperatively may reduce the lethality of operations. A palliative drainage of the biliary tract on the endoscopic or percutaneous transhepatic way as well as the endoscopic sphincterotomy may improve the patients' quality of life and prolong the survival time, when there are non-resectable tumours or a general inoperability.
Ampulla of Vater↗
[Biliary pancreatitis--pathogenesis, therapy, results].
According to current knowledge biliary (gallstone-associated) acute pancreatitis is induced by transient obstruction of the papilla by migrating gall stones. It seems, therefore, rational to remove the occluding stone as early as possible by endoscopic papillotomy (EPT). Uncontrolled studies have shown that patients with acute pancreatitis are not more endangered by EPT than those without pancreatitis and that the intervention seems to beneficially influence the course of the pancreatic disease. Early endoscopy (within 48 h), however, revealed incarcerated papillary stones only in 10% but common bile ducts free of stones in 24%. There seems to be only a small subgroup with acute biliary pancreatitis who might benefit from early EPT. This subgroup should be characterized more precisely. Early EPT indiscriminately performed in any kind of acute pancreatitis has little rational ground and is, up to now, not justified.
Acute Disease↗
[Does the duration of work disability in patients with uncomplicated duodenal ulcer affect risk of recurrence the following year? A multicenter study].
At present there is no therapeutic approach conducive to success, with the help of which the inclination to recidivation of duodenal ulcer might be restricted. In a prospective multicentric study with the help of two randomized groups of patients (group A: 13 days of disablement, group B: 37 days of disablement) was tried to prove a possible influence of the duration of the disablement on the inclination to recidivation in ulceration. In comparable groups of patients out of 99 evaluable documentations of patients in group A were found 62.5% of recidivations, in group B 68.6%. The difference was not significant. No connection could be found between duration of the disablement in ulceration and inclination to recidivation. Smokers have a distinctly higher inclination to recidivation than non-smokers.
Absenteeism↗
'Anestheticography': on-line monitoring and documentation of inhalational anesthesia.
The safe practice of inhalational anesthesia requires control over the amount of volatile anesthetic delivered to the patient. With minimal fresh gas flow this is facilitated by continuous monitoring and recording of the agent's concentration ('Anestheticography'). Alterations brought about by routine clinical maneuvers become visible. We recorded the course of the inspiratory and expiratory concentration of volatile anesthetic (Isoflurane) by infrared absorption and a trend recorder. Changing the carrier gas composition during high flow from 75% to 25% nitrous oxide in oxygen resulted in a 10% increase of the inspiratory isoflurane concentration. Activating the oxygen bypass or exchanging the soda lime canisters was followed by a prolonged disturbance of concentrations, most pronounced with minimal flow. Initiating emergence by closing the vaporizer during minimal flow led to a slow decrease in concentration whilst at a flow of 61/min the inspiratory isoflurane concentration rapidly decreased to subanesthetic levels. Insertion of a charcoal filter into the inspiratory limb of the breathing circuit immediately dropped the inspiratory concentration to undetectable levels. 'Anestheticography' is a useful means of monitoring and documentation of inhalational anesthetic. With the use of a charcoal filter all advantages of minimal flow anesthesia can be realized throughout the entire anesthetic, including emergence.
Anesthesia, Inhalation↗
[Coincidence of chronic pancreatitis and duodenitis].
Biopsies taken from various regions of the duodenal mucosa were investigated with a quantitative histological method with a view to frequency, quantity, and localisation of the duodenitis in clinically proven chronic pancreatitis. The histologic classification of duodenitis was made according to Whitehead et al. Out of 46 patients suffering from a chronic pancreatitis, 19 had a duodenitis grade 1 in the pars superior and pars descendens. A more frequent occurrence of duodenitis with concomitant chronic gastritis or a pathologic condition of the bile duct or a chronic alcohol abuse could not be proved statistically.
Aged↗
[Detection of radiogenic lung changes by comparing roentgen image, computerized tomography, scintigraphy and lung function].
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Humans↗
[Bupivacaine-CO2 and bupivacaine-HCl at various injection temperatures in peridural anesthesia for extracorporeal shock wave lithotripsy].
INTRODUCTION: The effect of different injection temperatures on carbonated anesthetics has been controversial since 1965. The current study was undertaken to determine onset times of sensory and motor blockade after epidural anesthesia with 0.5% bupivacaine-CO2 and 0.5% bupivacaine-HCl at various injection temperatures. MATERIALS AND METHODS: The study was performed on 90 ASA class I-II urologic patients during extracorporeal shock wave lithotripsy. The patients were randomized in six groups to receive either 0.5% bupivacaine-CO2 or 0.5% bupivacaine-HCl at temperatures of 4 degrees, 20 degrees, or 36 degrees C. The six groups were comparable in age, height, and weight. Epidural anesthesia was performed at the L2-3 interspace with an 18-gauge Tuohy needle using loss of resistance. A catheter was advanced 4 cm in the epidural space and 4 ml 0.5% bupivacaine with adrenaline 1:200,000 was given as a test dose. After 4 min the full anesthetic dose, based on body size, was injected with the patient supine. Sensory blockade was determined by the pinprick method and motor blockade by the Bromage method at 2-min intervals for the first 20 min, at 5-min intervals for the next 10 min, and then every 15 min to a total of 240 min. Statistical analysis was done by the Mann-Whitney test, with P less than 0.05 considered significant. RESULTS: Spread of sensory blockade was significantly faster with bupivacaine-CO2 and -HCl at a temperature of 36 degrees C as compared to 4 degrees or 20 degrees C (P less than 0.05) (Figs. 1, 2 and Table 2).(ABSTRACT TRUNCATED AT 250 WORDS)
Analgesia↗
Malignant hyperthermia susceptibility--successful management with a "stressfree" technique.
The pathogenesis of the malignant hyperthermia syndrome is not yet completely understood. There is evidence of involvement of the sympathoadrenergic system. We describe the anesthetic management of two patients considered to be MH-susceptible. Management in the theater included an infusion of dantrolene 2.5 mg/kg prior to induction of anesthesia. In addition, the first patient was given a peroral prophylaxis with dantrolene; in subsequent cases this route of administration was abandoned. Anesthesia was performed with a drug combination devoid of sympathomimetic effects (diazepam, flunitrazepam, midazolam,--methohexital,--fentanyl, alfentanil,--vecuronium). Monitoring should include ECG, blood pressure, body temperature and end-tidal CO2-concentration.
Administration, Oral↗
[Experiences with fiber endoscopic foreign body extraction from the upper gastrointestinal tract].
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Adolescent↗
Evaluation of two oxygen analyzers by computerized data acquisition and processing.
Monitoring of inspired oxygen concentration during anesthesia with nitrous oxide is becoming accepted as essential. This type of monitoring demands accurate monitors that respond rapidly. We evaluated two such devices for their response patterns to rapid changes in oxygen concentration, a galvanic or "fuel cell" unit and a polarographic device. Data were stored after analog-to-digital conversion. The response patterns to stepwise changes in nitrous oxide and oxygen mixtures were recorded at flow rates ranging from 2 to 10 L/min. Both units responded accurately to all changes in the absolute oxygen concentration; the polarographic unit was, on average, twice as fast. Responsiveness to nitrous oxide was low (less than 0.4% at 100% nitrous oxide), and the stability of the signals was good. The 90% response time (T90) was consistent for any stepwise increase or decrease in oxygen concentration between 0, 21, 33, 50, and 100%. After a step change from 0 to 100% oxygen at a gas flow rate of 10 L/min, the T90 was 5.8 seconds in the polarographic device and 11.4 seconds in the galvanic device (p less than 0.01). After a decrease from 100 to 0% oxygen, the T90 was 0.6 second longer in both monitors. Comparing flow rates of 2 L/min with 10 L/min, the T90 was delayed by 1.1 and 2.3 seconds for an increase, and by 1.4 and 2.9 seconds for a decrease in oxygen concentration. Experimental data suggest that both sensors respond adequately during routine clinical use. The faster response of the polarographic device is probably of limited clinical relevance, but it may aid in calibration.
Anesthesia, General↗
Effect of vecuronium on intraocular pressure.
Intraocular pressure decreased by 22.6% in association with neuromuscular blockade produced by vecuronium 0.1 mg kg-1. This appeared to be the result of an indirect action possibly via an effect on CVP. Vecuronium would be a suitable neuromuscular blocker for patients undergoing eye surgery in whom an increase in IOP would be undesirable.
Adult↗
[Spinal anesthesia with hyperbaric tetracaine and bupivacaine: velocity of spread, analgesic effect and motor blockade in various positions and injection volumes].
The effect of Trendelenburg position (5 degrees head-down) for 60 or 45 s on the spread of hyperbaric 0.5% tetracaine and 0.5% bupivacaine (3 or 4 ml) was studied in 80 patients scheduled for urological surgery. The mean spread of analgesia was faster (p less than 0.05) and greater (p less than 0.05) in patients tilted head-down for 45 s receiving 4 ml tetracaine than in those with 3 ml tetracaine and 60 s Trendelenburg position. With bupivacaine corresponding results of both volumes, 3 or 4 ml, were similar. Tetracaine compared with bupivacaine showed a faster cephalad spread with 4 ml (p less than 0.05) but not with 3 ml. The onset time of motor blockade in all groups was short (less than 10 min) and complete (Bromage III). The results prove that 4 ml of 0.5% tetracaine with 5% Trendelenburg position for 45 s ensure a rapid and safe spread of analgesia with adequate motor blockade for transurethral surgery.
Aged↗
[Biochemical diagnosis of duodenitis].
The activities of enteropeptidase, alanine aminopeptidase, sucrase, and leucine aminopeptidase were determined in mucosa biopsies taken from three defined places of the duodenum and in duodenal juice. We examined 23 adults with a histological proven normal mucosa and 10 patients suffering from duodenitis grade I. Using multivariate evaluation of all the four enzyme activities of the three mucosa sites, we could differentiate duodenitis from normal mucosa with an efficiency of 88%.
Adult↗
[The effect of rectal pH values on the absorption of methohexital].
The factors underlying the unpredictability of the pharmacokinetics of rectally administered methohexitone remain unclear. The "pH partition hypothesis" offers an explanation. We investigated six children with rectal pH values ranging from 7.5 to 9.8, who were given 25 mg/kg methohexitone 10% via the rectal route under general anaesthesia. Blood samples were taken at zero, 3, 5, 7, 10, 15, 20, 30, 40, 60, 90 and 120 min; rectal pH was measured at zero and 1 min. The methohexitone plasma levels reached a maximum (Cmax) of 2.63 micrograms/ml (median) after 17.5 min (median). The elimination half-life ranged from 37 to 218 min. No positive correlation between lower pH and better resorption (AUC and Cmax) was found. The resorption kinetics of rectally administered methohexitone cannot be explained by its electrochemical properties alone.
Anesthesia, Rectal↗