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Biomedical subjects

M Breulmann

Publications and source records attributed to M Breulmann.

11 recordsLinked to original sources
PubMed1991

[Recombinant tissue-type plasminogen activator for the emergency treatment of perioperative life-threatening pulmonary embolism (stage IV). Results in 7 patients].

We report a series of seven patients (age: 43-77 years, preoperative American Society of Anesthesiologists (ASA) physical status II-III) with perioperative, life-threatening pulmonary embolism and severe cardiogenic shock treated with recombinant tissue type plasminogen activator (rt-PA). Diagnosis was established by ECG (n = 7), arterial blood gas analysis (n = 7), massive elevation of mean pulmonary arterial pressure (MPAP: 40 +/- 6 mmHg SD, n = 7), echocardiography (n = 3), increased arterial/end-tidal CO2 difference (30 +/- 16 mmHg, n = 3), and pulmonary angiography (n = 4). All patients had to be ventilated, six with an FIO2 of 1.0. To achieve a mean arterial pressure of above 60 mmHg all patients received norepinephrine 0.4 +/- 0.2 microgram.kg-1.min-1 in combination with dopamine 11 +/- 5 micrograms.kg-1.min-1 (n = 6), epinephrine 0.13 +/- 0.04 microgram.kg-1.min-1 (n = 5) or dobutamine 14 +/- 6 micrograms.kg-1.min-1 (n = 3). In addition, six of seven patients had to be resuscitated by external chest compression (duration of resuscitation: 5 to 40 min) prior to or during the thrombolytic therapy. The dosages of rt-PA ranged from 10 to 150 mg, and the duration of administration up to 31 h. Six patients survived neurologically intact. In these six patients MPAP had decreased from 41 +/- 6 mmHg to 33 +/- 6 mmHg (P less than 0.05, Wilcoxon rank test) 2 h after the start of thrombolytic therapy, with concomitant reduction of vasopressor and inotropic support.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Successful treatment of massive pulmonary embolism with recombinant tissue type plasminogen activator (rt-PA) in a pregnant woman with intact gravidity and preterm labour.

We report a patient with massive pulmonary embolism and circulatory shock during pregnancy (31st gestational week) and preterm labour who has been successfully treated with recombinant tissue type plasminogen activator. Thrombolysis was performed using 10 mg.h-1 over 4 h followed by 2 mg.h-1 for 1 h 30 min resulting in complete resolution of cardio-respiratory symptoms. Except for slight bleeding from one puncture site no complications occurred. At 48 h after the end of thrombolytic therapy the patient was delivered spontaneously of a male preterm healthy infant. The relevance of this new thrombolytic agent in the treatment of massive life-threatening pulmonary embolism during pregnancy is discussed.

Adult↗
PubMed1990

[A successful lytic treatment of a perioperative pulmonary embolism necessitating resuscitation using recombinant tissue-type plasminogen activator].

We report a patient with massive perioperative pulmonary embolism (stage IV) and cardiac arrest who was successfully treated with recombinant tissue plasminogen activator (rt-PA). Thrombolytic therapy was started with 25 mg rt-Pa over 15 min followed by another 25 mg over 45 min. During the next 5 h 50 mg were infused, and thereafter an additional 50 mg over 24 h. No major alterations in the plasmatic coagulation profile were noted. With the exception of moderate blood loss from one puncture site, no further bleeding complications occurred. The relevance of this new thrombolytic agent in the perioperative management of acute, life-threatening pulmonary embolism is discussed.

Humans↗
PubMed1988

Extracorporeal CO2-removal with a heparin coated artificial lung.

Treatment of severe acute respiratory failure with extracorporeal gas exchange necessitating near complete systemic anticoagulation requires a delicate balance to be maintained between disseminated intravascular coagulation and hemorrhagic complications. The present study describes our first experience using a heparin coated extracorporeal artificial lung and circuitry during clinical extracorporeal CO2 removal. In spite of a partial thromboplastin time and activated clotting time within or close to the normal range, neither laboratory evidence for disseminated intravascular coagulation induced by the extracorporeal circuit nor thrombi in the pulmonary vasculature were found. Scanning electron microscopy of the heparin coated hollow fiber gas exchanger demonstrated only minor deposits on the surface. Use of a heparin coated artificial lung may enhance the margin of safety of extracorporeal gas exchange and ultimately broaden its indications.

Acute Disease↗
PubMed1988

[Surgical treatment of thoraco-abdominal and suprarenal aortic aneurysm].

Ninety-nine patients underwent surgery for thoraco-abdominal (n = 73) or suprarenal (n = 26) aortic aneurysm, between January 1, 1981 and May 10, 1988. The in-graft technique was combined with re-implantation of renal, visceral, and segmental arteries, using the method proposed by Crawford. Ischaemic tolerance of kidneys was extended by means of flush cooling and was more recently manipulated by means of prostaglandin E1. Spinal cord function had been monitored since 1985 by means of the authors' method of spino-electrogram reading, with intercostal arteries being re-implanted in cases of need. The intervention was survived by 79 patients, with ruptures in 69 per cent of all cases and no ruptures in 82 per cent. The rate of paraplegia amounted to seven per cent (with 2.5 per cent of survivors. 25 per cent of deaths, 18 per cent with dissecting aneurysm, and five per cent without dissection), and it depended on the extent of aortic replacement (Types I, II, and III for 773 patients and Types IV and V for 0/26). While the incidence of postoperative disorders of renal function, including temporary dialysis, was also somewhat related to the extent of aortic replacement (Types I, II, and III 22 per cent and Types IV and V eight per cent), it was clearly affected to a greater extent by the general condition of patients (ruptures in 50 per cent, intact and without dissection in nine per cent). Spinal monitoring and protection against ischaemia have substantially contributed to much better surgical results, in recent years. Surgical treatment, therefore, is recommended for patients with aneurysmol symptoms as well as for advanced cases of aneurysm, the more as rupture-related mortality has proved to be extremely high in spontaneous courses without surgical action.

Adult↗
PubMed1987

Prolonged extracorporeal CO2-removal in severe adult respiratory distress syndrome. Neuropathological observations in two cases.

Extracorporeal CO2-removal (EC-CO2-R) using a membrane lung system was applied for 12 and 20 days respectively in two young men with adult respiratory distress syndrome (ARDS). Neuropathological examination revealed only moderate hypoxic changes of unusual distribution. In the first case nerve cell loss in Sommer's sector of the hippocampus and focal incomplete necroses in both putamina were interpreted as the result of cardiac arrest at the onset of the disease rather than of chronic hypoxia. Findings in the second case were confined to nerve cell necroses of a minor degree in the cerebral cortex. Remarkably, the cerebellum was spared in both cases. Our observations suggest that EC-CO2-R was not associated with neuropathological findings which could be attributed specifically to this procedure.

Adolescent↗
PubMed1985

[Pulmonary function during a 10-day successful extracorporeal CO2 elimination in acute respiratory failure. Case report].

Extracorporeal CO2-removal (ECCO2-R) with low-frequency positive-pressure ventilation (LFPPV) may relieve the acutely injured lung from the burden and the risks of excessively high ventilatory minute volumes and airway pressures. It was the purpose of this study to document the evolution of lung function during clinical ECCO2-R with special emphasis on extravascular lung water. ECCO2-R was applied in a 21-year-old female patient suffering from severe post-traumatic infectious adult respiratory distress syndrome. The indication for ECCO2-R was based on the following findings: total static lung compliance 25 cm X cm H2O-1; arterial pO2 50 mm Hg with an inspiratory oxygen concentration of 100%; intrapulmonary right-to-left shunt over 50% of the cardiac output; and extravascular lung water 24 ml X kg-1 (normal 4.5-7 ml X kg-1). ECCO2-R was shown to provide satisfactory conditions for improving the above-mentioned abnormal parameters of pulmonary function. Pressure-limited low-frequency mechanical ventilation allowed successful management of several pneumothoraces with bronchopleural fistulas which occurred during the procedure. It is concluded that these complications of positive airway pressure would have led to the patient's death under the conditions of conventional mechanical ventilation.

Adult↗
PubMed1981

[Plasma level of etidocaine within the first two hours after axillary plexus block in healthy adults and patients with renal insufficiency (author's transl)].

The plasma level of etidocaine was studied within the first two hours of axillary block in 7 patients with renal insufficiency and 7 healthy adults. After 15-20 min the maximum of plasma concentration was found in the group with renal failure and after 30-45 min in the healthy adults. 30 min after the block the plasma level was 1,26 +/- 0,62 mug/ml in the ill patients and only 0,73 +/- 0,31 in the normal group. Using a mathematical model the ratio of permeation into the blood is significantly higher in the group with renal failure than in the healthy adults. The main reason for these results seems to be the acidosis, which is often combined with renal insufficiency. The meaning of these results for regional anaesthesia in patients like these is discussed.

Acetanilides↗