Biomedical subjects

K Stubbig

Publications and source records attributed to K Stubbig.

6 recordsLinked to original sources

PubMed1993

[Anesthesia and intensive therapy in autonomic dysfunction].

Familial dysautonomia (Riley-Day syndrome) is a rare genetic disorder that is transmitted via an autosomal recessive gene. The disease, typically involving Jewish children, affects the central nervous system and can be characterised by pathological deficits in peripheral autonomic and sensory neurones. The signs, which begin in early childhood, include poor perception of pain and temperature, poor co-ordination of muscles, emotional crises with hypertension and profound sweating, postural hypotension, and excessive vagal reflexes. We present the case of a 1.5-year-old child who underwent general anaesthesia for gastrostomy and fundoplication because of chronic aspiration. The technique consisted of balanced anaesthesia with invasive monitoring: intra-arterial line, central venous catheter, pulse oximetry, capnography, and monitoring of urinary output, temperature, and metabolic changes. Pulmonary problems included a dramatic decrease in SaO2 during intubation, massive bronchial secretions, and a high fluid requirement. The haemodynamic parameters remained stable. In the postoperative period, pulmonary problems included severe pneumonia with variable pulmonary shunting and requiring an inspired oxygen fraction of between 0.5 and 1.0, accompanied by bronchoconstriction, atelectasis, and profuse bronchial secretions. Controlled ventilation had to be maintained for 4 days. The cardiovascular system was unstable with intermittent episodes of bradycardia, tachycardia, and hypo- or hypertension. The patient also showed signs of autonomic crises, which were treated with diazepam. Although patients with autonomic dysfunction are at high risk in the perioperative period, they can be managed safely when therapeutic efforts are optimised.

Anesthesia, General↗

PubMed1992

[Suture fixation of a Swan Ganz catheter to the left brachiocephalic vein during re-thoracotomy].

This case report describes the intraoperative fixation of a Swan-Ganz catheter at the left brachiocephalic vein by a suture during rethoracotomy in a cardiac surgical patient. In case of a rethoracotomy by median sternotomy the right-sided veins should be preferred for the insertion of a Swan-Ganz-catheter. Furthermore the free mobility of the catheter should be controlled before closure of the thorax.

Brachiocephalic Veins↗

PubMed1992

Infectious risk of replacing venous catheters by the guide-wire technique.

During the perioperative period cardiac surgical patients are often monitored by pulmonary artery (PA) catheters. This catheter, which is floated through the right heart into the pulmonary artery, enables the intensivist to measure and calculate indices of myocardial performance. After a variable period of time this invasive monitoring can often be abandoned following cardiovascular stabilization in these patients, but patients usually still require a central venous (CV) access for diagnostic and therapeutic purposes. To place this CV catheter either a de novo puncture at a new site or a guide-wire change at the existing exit site through the PA catheter in place can be performed. Each de novo puncture is associated with a risk of traumatising internal vessels or organs. In contrast, guide-wire change avoids this risk but inherits a potential risk of transferring bacteria by manipulation of contaminated lines. Our study included 159 consecutive cardiac surgical patients in whom PA monitoring was established preoperatively and terminated within a period of up to 72 hours postoperatively. At random the PA catheter was replaced by a CV line either by de novo puncture or by guide-wire change. All CV lines were left in place for 7 days according to standard practice in our intensive care unit (ICU). After removal of CV catheters all catheter tips were cultured semiquantitatively by rollplate technique according to Maki (26) and subsequent immersion broth culture. A positive culture was defined as growth of one up to 15 colonies on the agar-plate or any microbial growth in the broth. A significant colonization was assumed in catheters yielding more than 15 colony forming units (cfu) on the blood agar plate (26). Our results show a significant risk of colonization and catheter-related infection associated with the guide-wire technique as opposed to the de novo puncture. The figures for relevant colonization were 33.3% in the guide-wire group as opposed to 10.5% in the de novo group. However, this difference was noted only in the subgroup in which replacement of PA catheters by CV catheters was performed beyond 48 h after initial insertion of PA catheters. Within the time intervals of 24 and 25 to 48 h, respectively, we could not detect any significant difference between groups.

Aged↗

PubMed1992

[Surfactant administration in acute respiratory failure].

We report the case of a 21-year-old man who developed adult respiratory distress syndrome (ARDS) after severe lung contusion due to a car accident. At the scene of the accident the patient was awake and oriented, but there were signs of hypoxaemia (SaO2 by pulse oximetry: 86%). The trachea was intubated in the emergency room and, after diagnosis of multiple rib fractures on the right side (the patient nos. 4-11) and emergency treatment, was extubated 16 h later. During spontaneous breathing there was no improvement of pulmonary function, and the patient was transferred to the intensive care unit 5 days later and reintubated because of acute respiratory failure. He then developed the signs of severe ARDS. No improvement occurred during conventional ventilatory treatment including inversed-ratio ventilation, high-frequency ventilation, and ventilation via a double-lumen tube. On day 15 a bovine surfactant preparation (38 mg/kg body wt.) was instilled into both lungs. Initially there was deterioration of the pulmonary function, probably due to crusts in the bronchial mucous membrane. After aspiration of the crusts at bronchoscopy, there was progressive respiratory improvement. The inspired oxygen concentration and PEEP level could be reduced, and the ventilatory ratio normalised within 14 days. This therapeutic intervention improved pulmonary function and probably led to the successful outcome after 36 days of ventilatory support.

Accidents, Traffic↗

PubMed1991

[Optimized analgesic sedation techniques for ESWL].

Analgo-sedation for ESWL treatment has been associated with a variety of problems. Minimal invasiveness of this technique should combine with haemodynamic stability as well as with adequate oxygenation. Patient acceptance has to be considered as another important aspect. Our study demonstrates the effectiveness of an analgosedative regimen with regard to these aspects. 50 ASA I-III patients scheduled for ESWL treatment were randomly allocated to receive either no premedication (n = 25) or chlorazepam as oral premedication (n = 25). The analgosedative technique was identical in both groups, consisting of atropine 0.25 mg, droperidol 5 mg (2.5 mg, if body weight less than 60 kg), and alfentanil 10 micrograms/kg intravenously. If necessary, repeated boluses of alfentanil 5 micrograms/kg were administered up to a maximum of 2 mg. Heart rates, arterial blood pressures, and peripheral oxygen saturation were measured during treatment. Post-treatment, patients were interviewed to assess the quality of analgesia. The results showed that our analgo-sedative regimen is suitable for ASA I-III patients. Stable heamodynamic conditions and adequate oxygenation were achieved in all patients. Patient acceptance was good. Patients with anxiolytic premedication benefited in terms of reduction in blood pressure and heart rate. The study also showed that anaesthesiologists may underestimate the pain intensity experienced and assessed by the patient.

Aged↗

PubMed1986

Comparison of bisoprolol with other beta-adrenoceptor blocking drugs.

beta 1-Selectivity or beta 1/beta 2-splitting, i.e., the selectivity ratio between the potency of a beta-blocking agent to block beta 1-versus beta 2-mediated responses, was assessed in 16 healthy male volunteers. The study was carried out to an intraindividual, randomized crossover design comparing bisoprolol (0.07 mg/kg i.v.) with the following beta-blocking agents: acebutolol (0.8 mg/kg i.v.), metoprolol (0.2 mg/kg i.v.), penbutolol (0.04 mg/kg i.v.), and propranolol (0.2 mg/kg i.v.). Exercise tachycardia was used as a mainly beta 1-receptor-mediated response: the beta-blocking effect was quantified as a work load ratio after/before beta-blockade for a given heart rate. Decrease in diastolic blood pressure after isoprenaline was used as a mainly beta 2-receptor-mediated response: the beta-blocking effect was quantified as an isoprenaline dose ratio after/before beta-blockade for a decrease in diastolic blood pressure of 25 mm Hg. Assessing the data for a beta 1/beta 2-splitting as 1 for propranolol, the relative beta 1-selectivity (mean +/- SEM) was 12.2 +/- 1.1 for bisoprolol, 9.0 +/- 0.9 for metoprolol, 6.2 +/- 0.6 for acebutolol, and 0.6 +/- 0.06 for penbutolol. There was a significant difference (p less than 0.01) between the cardioselective compounds bisoprolol, metoprolol, and acebutolol on one side, and the nonselective compounds propranolol and penbutolol on the other side. Within the group of nonselective compounds, propranolol and penbutolol differed from each other (p less than 0.05), penbutolol being even less beta 1-selective than propranolol. Within the group of "cardioselective" compounds, bisoprolol and metoprolol appeared to be superior to acebutolol (p less than 0.05). However, it cannot be dismissed that these within-group differences merely reflect the considerable decrease of plasma levels of acebutolol and penbutolol which were observed after ergometric exercise in comparison with the plasma levels after isoprenaline tests.

Adrenergic beta-Antagonists↗