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K Steinbereithner

Publications and source records attributed to K Steinbereithner.

At least 37 records · Page 2Linked to original sources
PubMed1990

Anesthesia in malignant hyperthermia susceptible patients.

The intra- and postoperative course of 30 general and 3 regional anesthetics in 27 MH-carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically. Disposable tubings were used for ventilation, vaporizers and soda lime were removed. ECG, esophageal temperature, blood pressure, oxygen saturation, and end tidal pCO2 were monitored. Minor tranquilizers were offered for premedication. Fentanyl, thiopentone, nitrous oxide, non depolarizing relaxants, neuromuscular antagonists and naloxone were used. In three patients, surgery was performed during epidural or spinal anesthesia with the use of amide local anesthetics. Neither MH-related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed in any patient. The anesthetic techniques used seem to be safe and reliable; the anesthetic management of known MHS patients is discussed in detail.

Adult↗
PubMed1989

Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome.

We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n = 108) were made at intervals of 6-12 h over a 48 h period. There were no significant differences between initial and final values of thermal-dye EVLW (5.0 +/- 1.1 vs. 5.7 +/- 1.1 ml/kg), plasma colloid osmotic pressure (COP, 13.3 +/- 2.5 vs. 13.2 +/- 2.9 mmHg), pulmonary artery wedge pressure (PAWP, 9.2 +/- 3.0 vs. 10.8 +/- 3.0 mmHg), and COP-PAWP gradient (4.0 +/- 3.5 vs. 2.4 +/- 3.9 mmHg). All results expressed as (mean +/- SD). The EVLW did not correlate with plasma COP, PAWP, or COP-PAWP gradient. We conclude that large volume replacement with balanced electrolyte solutions with the secondary decrease in plasma COP and COP-PAWP gradient do not necessarily contribute to a substantial increase in EVLW. This study fails to show any causal relationship between decrease in plasma COP or COP-PAWP gradient and oedema formation in the lung.

Adult↗
PubMed1989

[The action of ketamine on muscle contractile behavior. In vitro studies on the musculature of subjects susceptible to malignant hyperthermia].

Since ketamine has been incriminated as triggering malignant hyperthermia (MH) [3, 9, 13, 14, 18], but has still been used uneventfully in MH susceptible patients, we performed an in vitro study to examine the safety of ketamine for use in human MH. METHODS. Muscle specimens of 20 patients who had muscle biopsies to diagnose MH were investigated. In every patient diagnostic contracture tests (2 halothane (Hal) and 2 caffeine (Caf) were done according to the protocol established by the European MH group (EMHG). In addition, one test unit for investigating the effect of stepwise increased bath-concentrations of ketamine (5, 10, 20, 60, 120, 240 and 960 mumol/l) and a further one serving as control (no drugs added to the bath) were used. Combined Hal (2 vol%) and Ket (960 mumol/l) tests were performed in 9 patients (4 MHS, 4 MHN, 1 MHEh). Changes in baseline contractures and mechanical twitch tension were evaluated. RESULTS. The diagnostic test showed MHS in 8, MHN in 8 and MHEh in 4 patients. Ketamine did not induce baseline contractures in any of the tests performed. Contractures induced by 2 vol% of halothane in 4 MHS muscles did not change significantly when ketamine was added to the bath (concentration 960 mumol/l). A significant, dose-related decrease in mechanical twitch tension occurred, when ketamine was added to the test. At the highest concentration (960 mumol) twitch tension was reduced by 55%. Twitch tension remained stable in untreated muscles. No significant differences were found between the specimens from MHS, MHN and MHE patients. This reduction in twitch tension was more pronounced in specimens exposed to both halothane (2 vol%) and ketamine (960 mumol/l), resulting in an average decrease of 71%. CONCLUSION. In accordance with Fletcher et al., our results indicate that ketamine - at least in vitro - does not trigger MH. In MHS muscles, ketamine does not augment halothane-induced baseline contractures. The ketamine-induced reduction of mechanical twitch tension in directly stimulated human muscles has not been described before. Analogous findings in frog sartorius muscles can be found in the literature. Whereas the effect of ketamine on indirectly stimulated muscle has been investigated by several authors, the underlying mechanism of ketamine-induced twitch suppression in directly stimulated muscles is not known. Inhibition of calcium release from or accelerated uptake into the sarcoplasmatic reticulum have been reported.

Caffeine↗
PubMed1988

Malignant hyperthermia susceptibility confirmed in both parents of probands. A report of three Austrian families.

From 1976 to 1986, 79 cases of suspected malignant hyperthermia (MH) were reported to the authors' institution. A total of 233 muscle biopsies was done in 66 families. The mother and father of the proband were investigated in 44 families; in three of these, both parents of probands gave positive test results. These three families, all from Vorarlberg, a secluded mountain area, represent 4.5% of all our MH-positive families (n = 61) and 7.3% of all MH-positive families where both parents had been tested (n = 41). This observation might be explained by: 1) a much higher incidence of MH in this part of Austria, and 2) a different test policy, as at the authors' institution, if possible, both parents are investigated, even if there is a positive test result in one of them. It is concluded that family investigations of MH susceptibility should always include both parents of a proband.

Adult↗
PubMed1988

[Malignant hyperthermia in Austria. III. Anesthesia in susceptible patients].

Anesthesia in patients susceptible to malignant hyperthermia (MH) is generally considered to be very risky, although - with one notable exception - there are no prospective studies about anesthetic management in a large number of such patients. The prophylactic use of dantrolene has been recommended in MH patients, although there is no strong evidence supporting this - despite the fact that dantrolene may have serious side effects. We therefore decided to report the results of our own anesthetic technique for MH patients, as our technique does not include the prophylactic use of dantrolene. From 1981 to 1988, 19 operations on 16 MH-susceptible patients were performed. Patients 1-4 were pediatric survivors of an MH episode, where MH susceptibility was confirmed by muscle biopsy and in vitro contracture tests in at least one parent; patients 5-7 were survivors of an MH crisis, and they later underwent diagnostic muscle biopsies themselves; all other patients (nos. 8-16) were relatives of MH survivors with positive in vitro contracture tests. Diazepam, pentobarbital, pethidine, and chlorprothixene were used for premedication; no prophylactic dantrolene was given. Anesthesia was induced by thiopentone and was continued by nitrous oxide/oxygen, fentanyl, and droperidol; alcuronium, atracurium, and vecuronium were administered as necessary. Pyridostigmine, atropine, and naloxone were used if appropriate. New or disposable tubings were used for ventilation, and the vaporizers were removed from the anesthesia machines. ECG and body temperature were recorded in all patients; blood pressure was monitored invasively if indicated; end tidal CO2 was monitored whenever possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Malignant hyperthermia in Austria. II. A comparison of the results of diagnostic test procedures].

During the last 4 years different diagnostic procedures for the detection of malignant hyperthermia (MH) susceptibility have been used at the authors' clinical unit; this study was designed to compare the results of these tests. PATIENTS AND METHODS. Since March 1983, 158 patients have been referred for the following reasons: group A: probands (n = 17) who had had symptoms of MH during anesthesia; group B: patients of probands (n = 48) if the latter were not tested because of age (n = 24) or death (n = 2); group C: relatives from MH families (n = 86); group D: patients (n = 5) who developed fever during stress and/or physical activity (n = 3), had myotonia (n = 1), or developed rhabdomyolysis during intensive care (n = 1); group E: controls (n = 2). Two static halothane and two static caffeine tests according to the European protocol were performed in all patients (n = 158). Histological examinations of skeletal muscle (fixed in glutaraldehyde, stained with hematoxylin-eosin, Gieson, and toluidine blue) were done in the first 100 patients; all specimens were scored by the same investigator (E.S.). Score 0: normal; 1: increased number of sarcolemma cores; 2: 1+cores forming groups; 3: 1+2+fiber degeneration; 4: specific changes-myopathies. Plasma levels of creatine kinase (CK) were determined in the first 50 patients. Complete neurological examinations, including electromyography (EMG), were done in ten patients who had increased CK levels as well as histological scores of 3 or 4 (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Comparative review of various resuscitation procedures].

During the last 10 years many experiments have confirmed the theory that blood flow during CPR likely occurs as a result of manipulation of intrathoracic pressure. In order to improve vital organ perfusion by increasing intrathoracic pressure many different techniques of CPR have been developed. These include "new CPR" (simultaneous ventilation and compression), asynchronous ventilation, prolonged compression, and continuous or interposed abdominal compression. Other methods like open chest CPR and the use of mechanized CPR or even cardiopulmonary bypass have also recently been proposed. All these techniques are reviewed in detail.

Heart Arrest↗
PubMed1987

[Results of cardiopulmonary and cerebral resuscitation in the area of surgical intensive care].

In intensive care units specially trained staff and sophisticated technical equipment are confronted with extremely critically ill patients. In this patient population multiple organ failure is mostly established thus requiring application of all therapeutic facilities. During a study period of 40 months in 203 (86.4%) out of 235 patients with cardiac arrest a decision not to resuscitate ("DNR order") was made. In 32 patients cardiopulmonary resuscitation was attempted. Although spontaneous circulation could be maintained for at least 12 hours in 40.6% (13 patients), 6 died within the first day and 3 other patients died during the first week. Only 4 patients resuscitated could be discharged. Our data suggest that, despite further development of technical and therapeutic methods, the underlying disease has to be considered as the limitation of long-term survival.

Adolescent↗
PubMed1986

[Malignant hyperthermia in Austria. I. Epidemiology and clinical aspects].

Investigation of malignant hyperthermia (MH) was started in 1975; by March 1986, 79 suspected cases had been reported. In vitro contracture tests were performed in 66 probands or their parents; in 61 of these (92%), MH was confirmed and 5 (8%) proved negative. In 4 lethal crises, the parents refused biopsy, but because of well-documented clinical histories these were also included as confirmed MH reactions. We were able to analyse 65 cases of documented MH, and 9 patients are still to be investigated. About 18% of all Austrian hospitals (29 of 158) had reported 1-14 MH reactions (mean 2.7/hospital); it must therefore be assumed that a high number of crises are either not detected or not reported, and the total incidence of MH cannot be estimated. In our hospital (the University Hospital of Vienna), the incidence was 1:23,600 (including children and adults), whereas in Bludenz (Vorarlberg), the incidence was as low as 1:1,300 (in children only). This might partly be explained by genetic factors (such as inbreeding); we identified 3 families, all from Vorarlberg (which is a small, secluded mountain area), in which both parents were carriers of the MH trait. Fulminant crises (of which three times as many were rigid as were non-rigid) accounted for 58%, and masseter spasm for 26%, of all MH reactions. There was a significant influence of sex (72% males) and age (71% less than 20 years) on incidence. Neuromuscular symptoms or other signs reported to be associated with MH were found in only 5 patients (8%). During crises, cardiac symptoms (81%) and cyanosis (71%) were frequently observed; rigidity (45%) and body temperature above 39 degrees C (27%) showed remarkably low incidences. The overall mortality was 17% (11 of 65); it was significantly increased if the maximum temperature exceeded 39 degrees C, after acute surgery or anaesthesia lasting greater than 60 min, and in patients aged over 20 y. Most crises required no specific therapy; dantrolene was administered to only 10 patients. In the future, earlier detection via better monitoring, improved documentation, and mandatory reporting of suspected MH reactions should allow a more detailed description of MH and could further decrease the mortality associated with this condition.

Austria↗
PubMed1985

Potentiation of pancuronium induced neuromuscular blockade by calcium channel blockers in vitro.

The calcium channel blockers verapamil, methoxyverapamil, diltiazem, and nisoldipine have been tested for interactions with the nondepolarizing muscle relaxant pancuronium bromide by using the indirectly stimulated in vitro preparation of the rat hemidiaphragm. Dose response curves of each calcium channel blocker, pancuronium bromide, and combinations of both were determined. Each of the four calcium channel blocking drugs showed agonistic interaction in potentiating pancuronium induced neuromuscular blockade.

Animals↗
PubMed1985

[Interaction of the calcium antagonists nifedipine and nisoldipine with the nondepolarizing muscle relaxant vecuronium bromide in an vivo rat preparation].

The interaction of two orally administered Ca-channel blockers, the dihydropyridines nisoldipine and nifedipine, with the non-depolarizing muscle relaxant, vecuronium bromide, was tested in the indirectly stimulated tibialis anterior muscle of anesthetized and ventilated Sprague-Dawley rats. In both the nisoldipine and the nifedipine group, depression of twitch tension and duration of vecuronium-induced neuromuscular blockade was potentiated when compared with a control group. The possible clinical relevance of these findings is discussed.

Animals↗