Biomedical subjects
Publications and source records attributed to K Siegismund.
The anaesthetic procedure in patients affected with cardiac or other diseases during gynaecological laparoscopy has been reported. We tried with measurements of central venous pressure and control of acid-base-status to enable tese patients having laparoscopy, too.
The serum level of prolactin, estradiol (E2) and adrenocorticotropic hormones was determined pre-, intra- and postoperatively in 17 women with delivery by caesarean section. Three different anaesthetics were used before general anaesthesia and epidural anaesthesia. 9 women were able to nurse. Hormone levels of the nursing and non-nursing mothers were compared. An increased level of prolactin and significantly decreased of estradiol and adrenocorticotropic hormones was found in the nursing women postoperatively. The quotient of prolactin and adrenocorticotropic hormones is significant. It increased in nursing women in the childbed and remained almost constant with absent lactation. There were no differences according to methods of anaesthesia in hormones levels and secretion of milk.
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Report on one case of pulmonary gas embolism during gynaecological laparoscopy using nitrous oxide (N2O) as filling gas. There was only a slight symptomatology. An acute pulmonary infarction could be demonstrated by X-ray examination. A critical assessment of hemodynamic depression during laparoscopy is a demand. In this connection the advantage of carbon dioxide opposite to nitrous oxide should be emphasized.
667 cases inclusively 27 twin-births are evaluated in a retrospective study on the anesthesias administered in cesarean section (CS) from 1975 to 1983. The applied induction anesthetics hexobarbital, ketamine (Ketanest), propanidid (Sombrevin), etomidate (Radenarcon) and epidural anesthesia with bupivacaine (Marcaine) have been compared with each other concerning the Apgar scores of the newborns. Significant more depressed newborns have been found both in the hexobarbital group and to a low degree in the ketamine group. This tendency is also preserved when only the primary CS are taken into consideration. Besides the indications for the single anesthetics and methods of anesthesia, respectively, reference is made to the positioning of the mother and the avoidance of aspiration in the introduction of the anesthesia.
An etomidate/fentanyl anesthesia was administered in 112 minor gynecological operations. The endexpiratory percentage CO2-concentration and the expiratory percentage O2-concentration were determined under anesthesia by means of adequate dosage of anesthetics in two groups (group I: 16 women aged between 16 and 54; group II: 10 women aged between 60 and 75). The results reveal that the respiratory depression remains within acceptable limits in both groups. The blood gas values obtained capillarily before and after the operation show a normalisation of these parameters when the patients are transferred to the ward. On account of the minimal side-effects and the short waking-up time this method of anesthesia can be recommended as most favourable short anesthesia at present especially in concomitant cardiac disorders.
Arterial pressure, heart-rate, cardiac output, and blood-flow in the hepatic artery and the portal vein were recorded during the experimental death of the cerebrum in dogs. An increase of the hepatic blood-flow with a consistent portion in the heart time volume was to be seen in the beginning of the death of the cerebrum. A decrease of the hepatic blood-flow with a diminished portion in the heart time volume was detected in the state of brain death after 3 hours.
Lumbar epidural anaesthesia was applied for obstetric analgesia to 103 women, most of them primiparae. Three different concentrations of Bupivacain (Markaine) were used for local anaesthesia, percentages being 0.5, 0.375, and 0.25. Effects and side-effects were evaluated. -- The rate of vacuum extraction was slightly increased under epidural analgesia (24.3 per cent), with ejection periods being enlarged to average values between 82 and 63 minutes. Frequency of caesarean sections as well as both the acid-base status and Apgar scores of the newborns were similar to those recordable from comparison groups. -- Advantages were clearly visible and side-effects of minor importance. Catheterisation for lumbar epidural anaesthesia, consequently, is recommended as an optional approach to obstetric analgesia.
Postoperative analgesia was achieved by peridural injection of small doses of piritramide (Dipidolor Gedeon Richter Budapest) to 24 gynaecological and surgical patients. Periods of action were longer than those obtainable from equivalent intramuscular or intravenous injections. Undesirable side effects of the opiates, such as disorders of respiration, vomiting, clouded consciousness, and suppression of cough reflex, were not observed. The method did not affect locomotor and sympathetic nerve fibres and, consequently, proved to be superior to postoperative analgesia by means of local anaesthesia. Repetitive injections can be made by nurses. Peridural opiate analgesia can be recommended for postoperative situations and for other patients with pain.
Conduction anaesthesia was applied close to the spinal cord of 91 gynaecological patients whose risk in the context of surgery had been found to be increased on account of advanced age or for severe secondary internal diseases. The rate of complications of these patients with regional anaesthesia was compared to that of another group of 91 patients on whom operations were performed under general anaesthesia. The group with anaesthetic block close to the spinal cord exhibited less intra-operative variation in arterial pressure and less postoperative disorders of the respiratory organs. The metabolism of diabetic patients was more easily controlled and managed under regional anaesthesia. Conduction anaesthesia close to the spinal cord is recommended for patients in geriatric condition or with concomitant internal disorders.