Biomedical subjects

M Bayer-Berger

Publications and source records attributed to M Bayer-Berger.

6 recordsLinked to original sources

PubMed1990

[Flumazenil and peroperative awakening in surgery of scoliosis].

Motor and sensory function must be assessed during surgery of scoliosis so as to avoid possible damage to the spinal cord. The intraoperative awakening by a specific benzodiazepine antagonist, flumazenil, was studied prospectively in 20 patients (mean age 17 years) undergoing surgery for severe scoliosis. Premedication consisted in 0.02 mg.kg-1 atropine and 0.15 mg.kg-1 midazolam. Anaesthesia was induced with a mean dose of 0.42 +/- 0.1 mg.kg-1 midazolam, 1.6 +/- 0.6 micrograms.kg-1 fentanyl and 0.1 mg.kg-1 pancuronium. Maintenance was obtained with a continuous infusion of 0.22 +/- 0.1 mg.kg-1.h-1 midazolam, 66% nitrous oxide in oxygen, and fentanyl (1.6 +/- 0.5 micrograms.kg-1.h-1). Nitrous oxide and midazolam were respectively stopped 10 and 1 min before giving the antagonist (5 micrograms.kg-1 flumazenil) if required (17 out of the 20 patients). Eye opening occurred a mean 42 +/- 32 s after giving the antagonist. At this time, there was a significant increase in mean arterial blood pressure (+ 11 mmHg) and heart rate (+ 7 b.min-1). Thiopentone, 66% nitrous oxide in oxygen and 0.5% halothane were given to re-induce and maintain anaesthesia for completion of the procedure. The day following surgery, 19 patients were unable to remember the period of intraoperative awakening. One patient, although remembering the episode, did not experience any pain or any other disagreement in relation to it. Two patients were given a second dose of flumazenil at extubation so as to improve the quality of their recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

Prevention of arrhythmias by flecainide after noncardiac thoracic surgery.

Cardiac arrhythmias are a frequent complication after thoracic operations. The prophylactic value of flecainide administered as a constant-rate, intravenous infusion (0.15 mg/kg/h) after a loading dose (2 mg/kg) was tested in a randomized, placebo-controlled study in 30 patients using Holter monitoring during the first 72 hours after operation. A high incidence of atrial and complex ventricular arrhythmias was observed in the placebo-treated group, with a clear predominance in patients undergoing left thoracotomy. Antiarrhythmic drugs had to be added in 6 patients in the placebo-treated group (n = 16), but in none in the flecainide-treated group (n = 14) (p less than 0.01). The preventive effect of flecainide was observed at serum concentrations in the middle of the therapeutic range (409 ng/mL) without side effects. It is concluded that flecainide administration effectively reduced or prevented cardiac arrhythmias after thoracic operations.

Adult↗

PubMed1989

Incidence of phlebitis in peripheral parenteral nutrition: effect of the different nutrient solutions.

To determine the influence of peripheral parenteral nutrition (PPN) on the incidence of phlebitis and the effect of simultaneous infusion of lipid emulsion, 68 surgical patients were assigned randomly to 3 nutrition groups: (1) amino-acid 4% solution and dextrose 8% (AA + DX) + Intralipid (IL) 10% in the ratio 1.5:1 (2) AA + DX and IL 20% in the ratio 3:1 (3) AA + DX alone. Group 4 (control group) consisted of 25 patients receiving maintenance solutions and iso-osmotic drugs. No filters were used. The cannulae were studied for 72 hours and the cannula sites were evaluated daily for phlebitis. Mean age of patients was 52.3 +/- 17.7 years, with a similar sex ratio in the 4 groups. One hundred and twenty-five cannulae were studied. At 72 h, the following cumulated phlebitis rates were recorded: 22% in Group 1 (712 mOsm/L), 48% in Group 2 (802.5 mOsm/L), 44% in Group 3 (920 mOsm/L) and 26% in Group 4 (260-314 mOsm/L). The phlebitis incidence was similar in groups 1 and 4 (control) throughout the study. Both Groups 2 and 3 had higher phlebitis rates on days 2 and 3 (II: p < 0.05, III: p < 0.01). It is concluded that PPN with simultaneous IL 10% in the ratio 1.5:1 is no more phlebogenic than the usual maintenance solutions during the first 72 h. This is probably due to the lower osmolality and lower DX and K concentrations of the solution with IL 10%. Intralipid 20% does not have the same protective venous effect. The lower complication rate, the limited need for nursing, and lower costs compared to central parenteral nutrition, make PPN a safe nutrition technique for up to 10 days in patients needing no volume restriction.

Journal Article↗

PubMed1988

Hemofiltration clearance of flecainide in a patient with acute renal failure.

Flecainide, a new antiarrhythmic drug, has been shown not no be removed to a significant extent by hemodialysis or peritoneal dialysis, in spite of a high renal clearance. Its systemic and hemofiltrate clearances, measured in a patient under continuous hemofiltration, were 402 and 19.7 ml/min respectively. The clearance ratio of less than 5% makes the contribution of hemofiltration to the elimination of flecainide clinically negligible.

Acute Kidney Injury↗

PubMed1988

Thyroid function in severely traumatized patients with or without head injury.

The pattern of thyroid function changes following severe trauma was assessed prospectively in 35 patients during the first 5 days after injury. Patients were divided into 2 groups to evaluate the effect of head injury: group I, patients with severe head injury; group II, patients with multiple injuries without head injury. The results demonstrate a low T3 and low T4 syndrome throughout the study, with decreases in both total and free levels of T3 and T4, normal or increased rT3 levels, and normal TSH levels. The presence of severe head injury was associated with lower levels of TSH and free T3. Mortality was 37%. Survival was associated with higher TSH and T3 levels, but not with higher T4 levels. TSH levels exceeding 1 mU/l on the first day were only observed in survivors. These findings show that a typical low T3 and low T4 syndrome is present after severe trauma in patients with multiple injury as well as with head injury. Primary hypothyroidism can be excluded, pituitary or hypothalamic hypothyroidism is likely in these patients.

Adult↗

PubMed1987

Percutaneous transtracheal ventilation for laser endoscopic procedures in infants and small children with laryngeal obstruction: report of two cases.

The case reports of two children with obstructive lesions of the larynx are presented to illustrate the advantages of transtracheal ventilation for paediatric endoscopic laser surgery. The first patient was a four-month-old infant with inspiratory stridor due to a subglottic haemangioma obstructing 80 per cent of the lumen. The second patient was a five-year-old child with posterior synechiae of the larynx. The anaesthetic and ventilation techniques were the same for both cases. A transtracheal catheter was introduced percutaneously into the trachea under endoscopic control and connected to a high frequency jet ventilator. The advantages of this technique during laser surgery are: clear vision of the operative field, good gas exchange, elimination of airway trauma from intubation, reduction of the hazard of airway fires, and decreased risk of aspiration of blood and debris. In addition, this method of providing oxygen and/or mechanical ventilation may be extended into the postoperative period. In certain situations, this technique can be an attractive alternative to a tracheostomy with its potentially dangerous and incapacitating complications in infants and small children.

Airway Obstruction↗