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Biomedical subjects

K H Lindner

Publications and source records attributed to K H Lindner.

171 records · Page 10Linked to original sources
PubMed1984

The early use of positive end expiratory pressure (PEEP) ventilation in emergency medicine, and some experiments on pigs.

The effects on near drowning of young pigs of positive end expiratory pressure and zero end expiratory pressure were studied. The arterial PO2 and blood gases were examined during recovery from near drowning and after haemorrhagic shock. The cardiovascular parameters were measured after shock. The findings were considered in relation to the use of positive and expiratory pressure in patients. It was recommended that it be only administered by experienced staff in hospitals, and should not exceed 10 mbars, while 5 mbar was adequate and avoided complications in most cases.

Animals↗
PubMed1984

[Abdominal compression and PEEP respiration during cardiopulmonary resuscitation].

Three different resuscitation techniques were assessed by monitoring haemodynamic, respiratory, and cerebral parameters in 12 pigs of average body wt. (29 kg) following electrically induced cardiac arrest. All three techniques were carried out in randomised sequence, each for ten minutes, on each of the 12 animals. I = interposed ventilation and thoracic compression; S = simultaneous ventilation and thoracic compression; SA = simultaneous ventilation and thoracic compression plus abdominal binding 100 mm Hg. A compression rate of 60/min and ventilation rate of 12 min were used for each of the three techniques. 6 animals were ventilated with ZEEP for the whole of the 30 min observation period, the remainder with a PEEP of 5 cm H2O. In both ZEEP and PEEP groups the highest blood pressure and carotid artery flow rates were observed with the "SA" technique. PEEP ventilation and abdominal binding was found to be the most effective combination. Despite a rise in intracranial pressure, cerebral perfusion pressure rose when abdominal binding was applied. The CO2-production and arterio-venous oxygen difference of both ventilation groups were not significantly influenced by the different techniques. Even the technique "SA" did not markedly influence gas exchange or acid-base parameters. Despite an increase in the arterial base deficit and lactate levels during the course of resuscitation, the arterial pH did not fall below initial values because of the low paCO2. The positive effect of abdominal binding is a result of increased intrathoracic pressure, an increase in the effective circulating blood volume, and redistribution of blood flow.

Abdomen↗
PubMed1983

The delayed use of positive end-expiratory pressure (PEEP) during respiratory resuscitation following near drowning with fresh or salt water.

Investigations on the delayed use of positive end-expiratory pressure (PEEP) following a standardized form of near drowning with 12.5 ml/kg body weight of either fresh or salt water were carried out on 14 anaesthetized and ventilated young pigs. After a 3-min period of apnoea the animals were ventilated with 100% oxygen and with either the same or an increased tidal volume, and a PEEP of 5 cmH2O delayed to 20 min, over a period of 2 h. In both fresh and salt water, initial values of PaO2 and AaDo2 were regained by the end of the period of observation when a delayed PEEP was applied. The intrapulmonary right to left shunt, which increased to 40% of the cardiac output, fell by a half within 10 min of beginning PEEP ventilation, initial values being regained after 120 min. During the period of apnoea the arterial partial pressure of carbon dioxide almost doubled, and, when the tidal volume remained unaltered, was still some 20-30% above initial values at the end of 2 h, despite the use of PEEP. Normal PaCO2 levels were achieved on increasing the tidal volume by a factor of 1.4. The larger tidal volume had no influence on either the degree of shunt or the PaO2. The effective compliance, which was considerably reduced after near drowning, increased again with the use of delayed PEEP ventilation. On beginning respiratory resuscitation there was an initial tachycardia and, despite a fall in stroke volume, an increase in mean arterial pressure and cardiac output because of the previous hypoxia. Only minimal cardiocirculatory changes, and no change in oxygen availability, occurred secondary to the use of PEEP.

Animals↗
PubMed1982

[The effect of fenoterol on the incidence of arrhythmias during Caesarean section (author's transl)].

Beta-sympathomimetic tocolysis is an important part of modern obstetric therapy. Severe cardio-vascular complications have been described however, when inhalational anaesthesia was given following fenoterol-verapamil therapy. Alterations in clinical; cardiovascular parameters were measured in a prospective study on healthy women who had to undergo caesarean section and who had been treated with fenoterol-verapamil until the time of anaesthesia. The patients were given either halothane or enflurane as inhalational anaesthetic, and either an atropine premedication or none at all. Severe cardiovascular disturbances such as frequent extrasystole, arrhythmias or marked falls in blood pressure were not noted either during induction, whether following atropine or not, or during the course of anaesthesia with either 0.5 vol% halothane or 1.0 vol% enflurane.

Anesthesia, General↗
PubMed1982

[Delayed use of PEEP for respiratory resuscitation following standardized near-drowning with fresh and saltwater].

Investigations on the delayed use of PEEP following a standardized form of near drowning with 12.5 ml/kg body weight of either fresh or salt water were carried out on 14 anaesthetized and ventilated young pigs. After a 3 min period of apnoea the animals were ventilated with 100% oxygen and with either the same or an increased tidal volume, and a PEEP of 5 cm H2O delayed to 20 min, over a period of 2 h. In both fresh and salt water, initial values of paO2 and AaDO2 were regained by the end of the period of observation when a delayed PEEP was applied. The intrapulmonary right to left shunt, which increased to 40% of the cardiac output, fell by a half within 10 min of beginning PEEP ventilation, initial values being regained at 120 min. During the period of apnoea the arterial partial pressure of carbon dioxide almost doubled, and, when the tidal volume remained unaltered, was still some 20-30% above initial values at the end of 2 h despite the use of PEEP. Normal paCO2 levels were achieved on increasing the tidal volume by a factor of 1.4. The larger tidal volume had no influence on either the degree of shunt or the paO2. The effective compliance, which was considerably reduced after near drowning, increased again with the use of delayed PEEP ventilation. On beginning respiratory resuscitation there was an initial tachycardia and, despite a fall in stroke volume, an increase in mean arterial pressure and cardiac output because of the previous hypoxia. Only minimal cardio circulatory changes, and no change in oxygen availability, occurred secondary to the use of PEEP.

Animals↗
PubMed1982

[Left precordial ECG lead (V5) in patients with coronary artery disease (author's transl)].

In patients with and without coronary artery disease who were undergoing anaesthesia, the V5 precordial lead was recorded in addition to the limb leads. ST segment depression in the left precordial leads, especially V5, can be an indication of myocardial ischaemia, such as can arise during the stress of anaesthesia or operation. As a measure of myocardial oxygen usage, the rate-pressure product was calculated. No alterations of the ST segment were noted during general or regional anaesthesia in twenty patients free of coronary artery disease. In four out of ten patients with coronary insufficiency however, ST segment depression and pre-terminal T-wave negativity were recorded. This study shows that besides calculation of the rate-pressure product, a V5 lead recording is also a means of continuous monitoring for the occurrence of myocardial ischaemia.

Aged↗
PubMedDate not supplied

Effect of phenylephrine bolus administration on left ventricular function during postural hypotension in anesthetized patients.

STUDY OBJECTIVE: To investigate the effect of intravenous (IV) phenylephrine (PHE) bolus administration on left ventricular function in patients who developed postural hypotension during isoflurane anesthesia in the head-up tilt (reverse Trendelenburg) position. DESIGN: Prospective "before-after" trial. SETTING: Operation theater of a university medical center. PATIENTS: 15 ASA physical status I and II patients without cardiovascular disorders. INTERVENTIONS: The anesthetized patients were tilted from a supine horizontal to a 30-degree reverse-Trendelenburg position. Once a steady state was achieved, PHE 3 micrograms/kg was administered as an IV bolus dose. MEASUREMENTS AND MAIN RESULTS: Transesophageal echocardiography was used to assess left ventricular function. We measured blood pressure (BP); heart rate; left ventricular end-systolic and end-diastolic area, diameter, and wall thickness; and ejection time at baseline and after tilt, immediately before and for a period of 3 minutes after PHE injection. We calculated fractional area change (FAC), mean velocity of circumferential fiber shortening (mVcf), and end-systolic wall stress. Head-up tilt caused a reduction of mean arterial pressure [from 68 to 54 mmHg (mean)], end-systolic and end-diastolic left ventricular area (from 9.7 to 6.5 cm2 and from 19.2 to 13.1 cm2, respectively) and end-systolic wall stress (from 56 to 33 10(3).dyne/cm2). FAC and mVcf remained unaltered. PHE administration restored baseline values or overcompensated the changes caused by tilt. FAC slightly decreased in response to PHE (from 0.51 to 0.43), end-systolic wall stress increased to 83 10(3).dyne/cm2, and mVcf remained unchanged. CONCLUSION: PHE bolus administration effectively restored BP and cardiac filling, which were reduced after head-up tilt, without causing a relevant impairment of left ventricular function or an increase in end-systolic wall stress above the upper normal limit.

Adult↗
PubMedDate not supplied

Devices for expired air resuscitation.

OBJECTIVES: Expired air resuscitation is an essential part of first-aid and cannot be replaced by other measures. Because of the risk of transmitting infectious diseases, the use of devices is recommended. Three types are available--masks, tubes, and foils. PARTICIPANTS: Six masks (Air-Vita Bi-Protect, Laerdal Pocketmask, Dräger Hivita Mask E, Rescue-Med Device, Resuscitator, SealEasy Resuscitation Kit), five tube instruments (Dr. Brook Airway, Dual-Aid, Goettinger Tubus, Lifeway, Sussex Valve Airway), and two foils (Ambu Life-Key, Laerdal ResusciFace Shield) were studied. MEASUREMENTS: Inspiratory and expiratory resistance, valve leakage, ability to protect against infection transmission, and practicability (e.g., possibility of training on standard mannequins, seal) were measured and tested in the laboratory. RESULTS: Only a few of the mask and tube devices had low inspiratory and expiratory resistances. Some of the one-way valves failed. There were definite risks of provoking complications (vomiting, lacerations) when using tube instruments. CONCLUSIONS: Devices consisting of a foil have definite advantages, and seem to be more appropriate for the use by first-aiders [first responders].

Cardiopulmonary Resuscitation↗