[Organ donation and transplantation].
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Ethics, Medical↗
Biomedical subjects
K W Fritz
Publications and source records attributed to K W Fritz.
Differentiation of autonomic nervous activity in different stages of coma displayed by power spectrum analysis of heart rate variability.
The analysis of heart rate (HR) variability offers a noninvasive method to investigate autonomic nervous system activity in comatose patients. We analyzed three components of the HR variability in a group of comatose patients: the low-frequency band (LF), representing mainly sympathetic influence, the mid-frequency band (MF), representing sympathetic and parasympathetic influence, and the high-frequency band (HF), representing the parasympathetic influence. A value for sympathovagal balance was defined as LF/HF and MF/HF ratio. Moreover, the skin conductance level (SCL) and the skin conductance resistance (SCR) variability were recorded. The patient group consisted of 22 patients with traumatic brain injuries. Coma depth was assessed by the Glacow Coma Scale and artifact-free HR, SCL, and SCR were measured 75 times in the patient group. The results documented a significant gain in sympathetic nervous system activity corresponding with the state of emerging from coma. This gain was most pronounced in the HF component of the HR and in the sympathovagal balance between LF/HF. The findings in SCL and SCR variability endorsed this result. It is concluded that emerging from coma is accompanied by an increasing influence of the sympathetic nervous system on HR control. This leads to a change in the sympathovagal balance, i.e., a reintegration of parasympathetic and sympathetic activity.
Adolescent↗
[Spinal anesthesia for ambulatory arthroscopy. The view of the patients: results and patient's viewpoint].
UNLABELLED: Spinal anaesthesia for outpatients is a method that is not favoured in several reports without having representative data. It was our desire to investigate whether this method could be used without having dangerous side effects. METHOD: After knee arthroscopy in spinal anaesthesia, patients received a questionnaire. The questions could be answered anonymously in a "yes-no" fashion. Additionally, the patients received an accompanying explanation concerning the so-called health-structure law. RESULTS: Of a total of 85 patients; 70 sent back the questionnaire. Temporary neck stiffness was seen in 1 case, hypotension in 5, nausea in 2, emesis in 5, and fever in 3. Twelve patients had headaches, 67 were in good condition upon leaving the clinic. Sixty-four would prefer spinal anaesthesia for a subsequent similar procedure. Nine patients treated themselves at home, which is not permitted in outpatient procedures; 7 of these had headaches that may have been secondary to the dural puncture. No severe side effects were seen. CONCLUSIONS: 1. Spinal anaesthesia is a method that can also be performed in out-patients. 2. an increased incidence of post-dural-puncture headaches may be seen due to the early mobilisation of the patients; 3. the patient must be treated by a second person; 4. premedication must be performed 2 days before the procedure to determine ASA status; and 5.better co-operation between surgeons and anaesthesiologists must be sought.
Adult↗
[Long-term unrecognized foreign body aspiration as the cause of pleural effusion].
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Airway Obstruction↗
[Undetected esophageal foreign body aspiration in a patient with seizures].
We report an oesophageal foreign body in a patient with a seizure disorder secondary to encephalitis disseminata who was transferred to our department of neurosurgery because of rising intracranial pressure. He presented with confusion, motor aphasia, and dysphagia. However, the diagnosis of increased intracranial pressure could not be confirmed clinically or by computed tomography. A routine chest X-ray film showed a dental prosthesis projecting on the area of the hypopharynx. Bronchoscopy and oesophagoscopy showed the denture to be lodged in the hypopharynx, but it was impossible to remove it endoscopically. Therefore, an oesophagopharyngotomy was performed and the foreign body extracted. The postoperative course was complicated by pneumonia, which responded well to antibiotic treatment. The patient made an otherwise uneventful recovery and was able to eat without difficulty.
Adult↗
[Life threatening tension pneumothorax after puncture of the subclavian vein and dislocation of thoracic drainage].
The combination of two rare complications in intensive care caused an acute life-threatening situation. Following puncture of the left subclavian vein a pneumothorax developed over the course of a couple of days. The inserted thoracic drain dislocated into the subcutaneous tissue. During the induction of anaesthesia and controlled ventilation a tension pneumothorax developed. A decrease in oxygen saturation and an increase in the ventilation pressure led first to the diagnosis "malposition of the double lumen endotracheal tube", but its correct position could be confirmed by bronchoscopy. Finally, the tension pneumothorax was diagnosed by x-ray of the chest. This life-threatening situation could be treated by the insertion of a thoracic drain. The operation could be performed without any problems.
Catheterization, Central Venous↗
[Toxic shock syndrome caused by Streptococcus pyogenes].
Necrotizing fasciitis and myositis due to Lancefield group A beta-haemolytic streptococcal infection is a medical emergency. Survival depends on aggressive early wound management as well as high-dose intravenous antibiotics. We report about a 28-year-old man with fulminant necrotizing fasciitis and myositis of his right arm, in whom many features of the toxic shock syndrome were present, including profound hypotension and renal failure. After extensive surgical debridement with amputation of his arm in combination with high-dose intravenous penicillin G the patient recovered from this serious infection.
Adult↗
[The humidification of anesthetic gases during anesthesia using heat and moisture exchangers].
This study looks at the question of whether anaesthetic gases are sufficiently moistened in a semi-closed system by the partial recycling of expired air with simultaneous absorption of CO2. During the inspiration phase only a maximum of 42% relative humidity at a temperature of 24.8 degrees C was reached. These values lie far below the demands of the American National Standard Institute (ANSI) of 70% relative humidity at 30 degrees C. When various heat and moisture exchangers were used, the relative humidity improved to 99% at a maximum temperature of 30.3 degrees C (HME Edith; Engström Corporation). The maximum values of the BB 12-15, Pall Corporation, and SH 150 from Siemens were slightly lower. A marked fall was noticed when using the Humid Vent I of the Medimex Corporation, especially in the initial phase. An improved version, the Humid Vent II, has been produced. Physiological values (37 degrees C, 100% relative humidity) are not achieved by any heat and moisture exchangers. This problem could possibly be solved by using infra-red light when warming the gases.
Anesthesia, Inhalation↗
Single potential analysis of cavernous electrical activity.
Recording of cavernous electric activity was performed in 178 patients with erectile dysfunction and in 37 normal patients. In 34/37 normal patients, potentials of a uniform shape were recorded during flaccidity: At cut-off frequencies of 0.5-500 Hz, the length was 8-18 (mean 12.8, SD 2.8), the amplitude 250-750 (mean 444, SD 109) microV, and the polyphasity 8-22 (mean 13.8, SD 3.3). In impotent patients with upper motor neuron lesions or peripheral lesions, specific types of potentials were observed. In 11/14 impotent patients with insulin-dependent diabetes for over 20 years and clinical findings of cavernous myopathy, potentials showed low amplitude, irregular shape, and slow depolarizations. In 51% of the consecutive impotent patients, abnormal findings of cavernous electric activity were recorded. Our clinical study suggests that single potential analysis of cavernous electric activity (SPACE) may be useful in the diagnosis of cavernous autonomic neuropathy and cavernous smooth muscle myopathy.
Action Potentials↗
[Orthotopic liver transplantation following heart transplantation].
Heart transplantation was performed in a 24-year-old man suffering from dilated cardiomyopathy who was also infected with hepatitis B virus and had not yet seroconverted. Most likely due to the immunosuppression, the hepatitis exacerbated and soon led to hepatic dystrophy and precoma. In this phase of congruent rejection of the heart transplant, liver transplantation was performed. During the procedure the patient had stable circulatory parameters and a reduced cardiac output. The heart rate and cardiac output stabilized after release of the anastomosis of the hepatic vessels. The patient survived for 6 months and died at home with signs of a myocardial infarction.
Adult↗
[A review of the present status of liver transplantation].
Liver transplantation opens the view on the border lines of medicine. Its performance requires great surgical and anaesthesiological experiences. Based on the authors' own experience the selection of liver donors and the indications for liver transplantations are pointed out. Special pathophysiological aspects of liver transplantation as well as the anaesthesiological procedure and the intensive care in the early postoperative period are described. The results of liver transplantation can be improved by further research on preservation of explanted organs, early recognition of complications after transplantation and immunological suppression.
Anesthesia↗
[Positioning the central venous catheter using intra-atrial ECG].
In a small study (n = 9) central venous catheters were positioned in front of the right atrium using ECG. ECG was registered using a soft J-wire inside of the catheter. Big vessels were cannulated and in all cases cannulation was successful. ECG and x-ray control showed good agreement.
Catheterization, Central Venous↗
[The effect of diazepam and midazolam on the circulation and respiration during spinal and peridural anesthesia].
Diazepam (0.21 mg/kg; group 1) and midazolam (0.03 mg/kg; group 2) was applied for sedation in two groups of urological patients (n = 10 in each) requiring transurethral resection (urine bladder, prostata) using spinal or peridural anaesthesia. Before anaesthetic procedure, 500 ml hydroxyethyl starch were administered for precluding severe vascular depression. Patients receiving midazolam began to sleep within one minute. Heart rate dropped in both groups after injection of both benzodiazepines which was considered a physiological sleeping effect. No hypotensive reactions were registered. Using this therapy maximum PaO2 values of 14.9 kPa in group 1 (diazepam) were registered and of 14.0 kPa in group 2 (midazolam). During the operation all patients were arousable. Side-effects such as nausea, vomiting and confusion were not observed.
Aged↗
[The effect of midazolam on blood circulation and respiration during spinal anesthesia in urology].
Ten urological patients with spinal anesthesia were sedated with midazolam 0.03 mg/kg i.v. A similar group (n = 10) was given placebo instead of midazolam (2 ml 0.9% NaCl). Patients who received midazolam slept lightly but were rousable. During the operation 2 l/min oxygen was administered via a nasal cannula; pO2 and pCO2 remained within normal limits throughout the procedure. No cardiovascular side effects such as hypotension or other reaction such as vomiting, nausea, or confusion were observed after midazolam. At the end of the operation all patients were fully awake and cooperative.
Aged↗
[Successful resuscitation in accidental hypothermia following drowning].
After breaking through thin ice, a 4-year-old boy drowned in a lake. A quickly alerted rescue helicopter found and recovered the child, drifting underneath the clear, thin ice. Primary resuscitation by the helicopter crew was unsuccessful. Upon arrival in the hospital the child had fixed, dilated pupils and asystole. Core temperature was 19.8 degrees C. Rewarming was conducted slowly while cardiopulmonary resuscitation was continued. Twenty minutes after arrival at the hospital, ventricular complexes appeared in the ECG (temperature 22.1 degrees C); after another 10 min this converted to sinus rhythm. At short intervals, blood gas analyses and electrolyte determinations were carried out and corrected adequately. For cerebral protection methohexital was given and the child was hyperventilated. Seventy minutes after arrival at the hospital the child was brought to the pediatric ICU with stable circulation. There, further rewarming (centrally/peripherally combined) was carried out, aiming at 1 degree C rewarming per hour until a normal temperature was reached. The patient had to be kept on the ventilator for 10 days and after another 2 weeks was discharged home. He had recovered completely without any cerebral damage. One of the reasons why 88 min of cardiac arrest were tolerated by this patient without sequelae may have been rapid and deep hypothermia.
Body Temperature Regulation↗
Initial experience with local anesthesia in extracorporeal shock wave lithotripsy.
The report concerns initial experience with local anesthesia in the treatment of urolithiasis by extracorporeal shock wave lithotripsy. This form of anesthesia is well tolerated for stones of limited size and hardness, though the patients must be carefully selected.
Anesthesia, Local↗
[Vocal cord synechia following short-term intubation].
A female of 17 years with a brain-damage was short-term respirated within the operation. After this procedure tracheotomia was performed for long term respiration. Fourteen months after the accident a synechia of the vocal cord was seen which caused impossibility of intubation. The reason for this synechia may be granuloma after tracheotomia with accompanying dysarthria of the vocal cord and reduced movement.
Adolescent↗
[A clinical study of circulatory depression and pharmacokinetics following peridural anesthesia with bupivacaine 0.75%. Preoperative phase].
In previous study it was demonstrated that the clinical use of bupivacaine 0.75% for peridural anesthesia appears to be without risk. There was seen no toxicity (bradycardia, convulsion, respiratory depression etc) at the measured plasma levels. Very important is the early onset of action of this drug contrary to the other used concentrations. It is useful for a major surgery. Hypotension can be avoided by applying volume transfusion.
Anesthesia, Epidural↗