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Biomedical subjects

K Eyrich

Publications and source records attributed to K Eyrich.

At least 19 recordsLinked to original sources
PubMed1995

Safe and normothermic massive transfusions by modification of an infusion warming and pressure device.

A fluid-warming pressure infusion device (H-500/H25i, Level 1) was modified to meet the demands for safe, normothermic, and effective massive transfusions. By incorporating an autoventing 40 microns filter (Pall AV-SP), which was originally manufactured for use in an extracorporal circulation, the risk of accidental air embolism can be eliminated. Feasibility and efficiency of this model were tested in ten patients. The mean volume transfused and infused (packed red cells and colloids) was 6750 mL (SD +/- 2519) during a mean period of acute volume resuscitation of 55 minutes (SD +/- 30). Calculated flow rates averaged 140 mL/min, which were sufficient to stabilize all but one patient. This patient subsequently died because of uncontrollable surgical bleeding. Body temperature remained stable with a minimal mean drop of -0.3 degrees C. Supplying the Level 1 warming and pressure device with a Pall AV-SP filter allows for safe, effective, and demand-adapted massive transfusions in a large number of trauma patients at a reasonable cost.

Blood Transfusion↗
PubMed1994

Venous and paradoxical air embolism in the sitting position. A prospective study with transoesophageal echocardiography.

This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE.

Adult↗
PubMed1994

[Intraoperative transesophageal versus preoperative transthoracic contrast echocardiography. A method for detection of patent foramen ovale in neurosurgical patients].

Preoperative detection of a patent foramen ovale (PFO) may be achieved employing either transthoracic echocardiography (TTE) with the Valsalva manoeuvre in the awake patient or trans-oesophageal echocardiography (TEE) in the anaesthesised patient. Our study was undertaken to validate these methods with regard to their efficacy in identifying patients at risk for paradoxical air embolism (PAE). METHODS. In 67 patients ranging from 28 to 70 years of age, TTE was performed utilising the Valsalva manoeuvre prior to surgery. The patients were informed about all procedures and agreed to take part in the study. After induction of anaesthesia the patients were evaluated with TEE in the supine and sitting positions. At end-inspiration 10 ml agitated gelatine solution (Gelafundin) was injected through a central venous catheter into the right atrium after airway pressure of 20 cm H2O had been maintained for 5 s. The injected bolus was observed throughout the ventilatory cycle, with special attention being given to early expiration and systole. A right-to-left shunt was assumed if five echo targets were observed in the left atrium. RESULTS. The prevalence of PFO detected by TTE/Valsalva was 9%. The diagnosis was confirmed by TEE in 2 patients in the supine and 1 in the sitting position. An echocardiogram in these patients showed bulging of the septum to the left, which was not seen in those patients in whom PFO was detected only by TTE. DISCUSSION. The reason for the lower incidence of PFO detected by TEE during airway pressure 20 cm H2O may have been an insufficient increase of pressure in the right atrium with a negative right-to-left atrial pressure gradient. A standardised ventilation manoeuvre with supra-atmospheric airway pressure of 20 cm H2O is not sufficient. Bulging of the intra-atrial septum from right to left during airway pressure is a possible indication of the efficacy of the manoeuvre, regardless of the influence of the breathing pattern.

Adult↗
PubMed1994

[Cardiac effects of atropine in patients treated with antidepressive medication].

UNLABELLED: It is often suggested that atropine should be avoided in patients on treatment with tricyclic or tetracyclic antidepressants. It is feared that the strong anticholinergic side effects of these drugs could exaggerate the effects of atropine on the heart. METHODS: In a controlled prospective study, 31 patients on treatment with tri- or tetracyclic antidepressants were given atropine in incremental doses. ECG-changes and changes in heart rate were recorded and compared to a control group. Atropine 2 micrograms/kg was administered in 60 sec. intervals up to a total dose of 10 micrograms/kg. RESULTS: The patients on antidepressant treatment had a higher incidence of common anticholinergic side effects (dryness of mouth, accommodation disorders, constipation) due to the anticholinergic properties of the antidepressants. In addition, the basal heart rate of these patients was significantly higher compared to the control group (81/min vs. 73/min). After administration of 2 and 4 micrograms/kg of atropine the patients of the control group showed a 5% resp. 4% decrease in heart rate. 26% of these patients developed conduction disturbvances. These changes could be explained by the parasympathetic effect of low doses of atropine. They were less pronounced in the patients on treatment with antidepressants. Here, only the administration of 2 micrograms/kg of atropine led to a 2% decrease in heart rate. Only 6% of these patients developed conduction disturbances. Both groups showed an increase in heart rate when higher doses of atropine were administered (8 and 10 micrograms/kg). However, the increase in heart rate after administration of 10 micrograms/kg was significantly less in the patients on antidepressant treatment compared to the control group (11.4% vs. 16.2%). There were no changes of blood pressure during these investigations. CONCLUSION: The results of this study suggest that the anticholinergic properties of tri- and tetracyclic antidepressants include an increase in basal heart rate, but do not render the heart more susceptible to the cardiac effects of atropine.

Adult↗
PubMed1992

[Muscular dystrophy as a risk factor in anesthesia].

Three cases of muscular dystrophy are reported on (8 years, 4 months, 10 months) in which serious conditions arose under anaesthetic (bradycardia, asystolia, hyperkalemia, rising CPK). In the first two cases there was no way of avoiding a fatal outcome, but in the third case the child survived with no permanent damage. The cause of incidents of this kind is discussed first as being hyperkalemia due to acute rhabdomyolysis, and secondly malign hyperthermia. There were no indications of malign hyperthermia in this case. It is hardly possible to distinguish this in an acute clinical ward, as the clinical symptoms are very similar. If it is known that muscular dystrophy is present, depolarising relaxants should be given sparingly. This also applies, as the first case shows, for muscular dystrophy of the Becker type, which can on the whole be regarded as benign in comparison with progressive muscular dystrophy of the Duchenne type. In this instance a forensic and anaesthetic expert's opinion even had to be produced at the request of the Public Prosecutor. The post mortem was carried out under the heading of a possible "mistaken medical treatment" but there was no evidence to justify such an assumption.

Anesthesia, General↗
PubMed1991

[The status of anesthesiology in Berlin].

At present in West Berlin hospitals (whether university, state run or private) almost 450 anaesthesiologists carry out 140,000 anaesthesias of all types a year through their individual anaesthesiology institutes with their corresponding head physicians. The specialist portion with a variation between almost 0 and 100% is on average 45%. The state run anaesthesiological care is supplemented by established anaesthesiologists in private practice or group-clinics. Operative intensive care lies largely in the hands of anaesthesiologists, as does to some extent--particularly in smaller hospitals--the care of conservative intensive care patients. Intensive care and likewise anaesthesiology for serious burns is carried out in a special department at "Urban Hospital". In contrast to days gone by, increasing numbers of anaesthesiologists are now involved in emergency medicine, frequently working on prominent joint projects together with internist colleagues. A rescue helicopter authorized for West Berlin is based at University Clinic Steglitz. Pain management is practised at only a few hospitals. In the entire area under review, a substantial deficit exists in this field, a deficit which would be quickly eliminated, despite substantial administration and emotional difficulties. Not unproblematic is the insufficient number of nursing personnel. Here again deficits exist with regard to equipment and the filling of vacancies.

Anesthesiology↗
PubMed1990

[Alcohol withdrawal syndrome in the postoperative phase--therapy or prevention?].

In a prospective study 50 patients who reported regular ethanol consumption and who underwent neck dissection were evaluated by clinical examination and the Munich alcohol test (MALT). 31 patients were not classified as alcohol abusers and none of them developed withdrawal symptoms (WS) postoperatively. 19 patients were diagnosed as alcohol abusers; 9 of them (group 1) received symptomatic therapy with clomethiazol and haloperidol, 10 patients (group 2) received continuous ethanol infusions (2-4 g/h) postoperatively as prophylaxis for WS. 6 patients in group 1 developed WS; none of group 2 developed WS. Thus the period of intensive care therapy of group 2 was significantly shorter (3.0 versus 11.5 days). It was concluded that postoperative continuous ethanol infusions prevent the occurrence of WS and should be administered to severely alcoholic patients.

Alcohol Withdrawal Delirium↗
PubMed1990

[Long-term antidepressive medication-- an increased anesthetic risk?].

Antidepressants inhibit the re-uptake of norepinephrine at the monoaminergic synapse from the synaptic fissure, leading in this way to an increased sensitivity to catecholamines. In addition, antidepressants have alpha1-, H1- and H2-receptor blocking effects and also anticholinergic effects; the tricyclic antidepressants in particular are known for these properties. A few animal experiments and some case reports indicate that a long-term treatment with these substances can lead to intra-operative blood pressure fluctuations, tachycardia and arrhythmias. Therefore a number of authors recommend that antidepressants be withdrawn 3 days before a planned operation. In view of the pharmacokinetics of these substances and the long-term adapting processes at the monoaminergic synapse this period is certainly too short to achieve complete loss of effectiveness. Other authors think preoperative withdrawal is not indicated if there is careful intraoperative monitoring. We agree with the latter opinion. Inhalation anesthesia with isoflurane or enflurane should be preferred. The muscle relaxant pancuronium should not be used, and exogenous intake of catecholamines should be avoided. Opiates seem to have a positive effect on cardiac stability. Benzodiazepines show the least interactions with antidepressants and are therefore recommended for premedication. In the postoperative period the possibility of an anticholinergic syndrome has to be considered.

Anesthesia↗
PubMed1989

[The effect of pre-oxygenation on hemodynamics and oxygen consumption].

Pre-oxygenation is routinely used prior to anesthesia and intubation. In awake, premedicated patients scheduled for major aortic surgery we assessed the effects of breathing oxygen for 10 min via a loosely fitting face mask on hemodynamics and oxygen consumption (VO2). RESULTS. O2-breathing increased arterial PO2 to 51 +/- 13 kPa and decreased VO2 from 109 +/- 18 to 92 +/- 24 ml.min-1.m-2 (P less than 0.001 for both variables). This reduction of VO2 resulted from both a fall in cardiac index from 3.22 +/- 0.67 to 3.04 +/- 0.75 1.min-1/m-2 (P less than 0.05) and a decrease in arterio-venous oxygen content difference from 3.45 +/- 0.60 to 3.03 +/- 0.57 ml/dl (P less than 0.001). Systemic peripheral vascular resistance increased slightly from 1453 +/- 359 to 1538 +/- 383 dyne.s.cm-5.m-2 (P less than 0.05). CONCLUSIONS. These results indicate that an increase in F1O2 in patients without severe limitations of oxygen uptake by the lungs or oxygen transport to the tissues does not improve tissue oxygenation. We speculate that increased peripheral shunting acts to protect tissue PO2 during high arterial PO2 levels.

Aorta, Abdominal↗
PubMed1989

Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship.

The effects of thoracic epidural anesthesia (TEA) on total body oxygen supply-demand ratio are complex due to potential influences on both O2 delivery (QO2) and consumption (VO2). One hundred and five patients undergoing abdominal aortic surgery were randomly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with (1) thoracic epidural anesthesia plus light general anesthesia (group TEA); (2) general anesthesia with halothane (group H); and (3) neuroleptanalgesia (group NLA). Values of cardiac index (CI) and QO2 were less intraoperatively in the TEA group than in the H or NLA groups, while VO2 values were similar. VO2 during recovery was greater in both the TEA and NLA groups than in the H group. Consequently the oxygen supply-demand ratio (QO2/VO2) was less in the TEA group throughout the perioperative period and about 30% below baseline values during early recovery. At comparable VO2, CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group. Heart rate was slowest intraoperatively during TEA, and stroke work was less with TEA than with NLA. As cardiac filling pressure and systemic vascular resistance did not differ among the three groups, reduced adaptation of CI to tissue O2 needs during TEA was attributed to negative inotropic and chronotropic effects of the sympathetic blockade. We conclude that in patients undergoing abdominal aortic surgery, TEA has no apparent advantage over general anesthesia.

Anesthesia, Epidural↗
PubMed1989

[Catheter induced rupture of a proximal pulmonary artery caused by vigorous coughing in a spontaneously breathing patient].

A complication is occurred during insertion of a pulmonary artery catheter in a 73-year-old woman with class III NYHA cardiac failure. After easy insertion of the catheter, massive haemoptysis developed as the patient coughed while the balloon of the catheter was inflated. Despite prompt emergency measures, the patient did not survive. Autopsy revealed a 2.7-cm perforation of the proximal pulmonary artery with penetration into the right lower lobe bronchus. This complication and its prevention are discussed.

Aged↗