Biomedical subjects

M Hirschauer

Publications and source records attributed to M Hirschauer.

10 recordsLinked to original sources

PubMed2000

[Experience with G27 Whitacre needle in in-patient and out-patient settings--incidence of post dural puncture headaches and other side effects].

OBJECTIVE: The aim of the study was to evaluate the incidence of side-effects in patients bearing a high risk of post dural puncture headache (PDPH) when a spinal anaesthesia was performed. This included outpatients, patients for sectio caesarea and patients younger than 40 years who were mobilized as soon as the surgeon agreed. METHODS: Quality control without randomization. Spinal anaesthesia for sectio caesarea was applied with a G27 Whitacre needle with the patient in the right lateral decubitus position. Hyperbaric Bupivacain 2-2.2 ml (10-12 mg) was injected when spontaneous flow of spinal fluid occurred through the needle. The preparations for the surgery then started immediately with the patient in a left lateral position. Intravenous Ephedrin (10-20 mg) was given simultaneously. All the other spinal anaesthesias were performed in a similar manner with the patient lying on the side of the scheduled surgery. For outpatients Articain was used instead of Bupivacain. In those outpatients older than 60 years a 26 G Quincke needle was used for spinal anaesthesia. Interviews: All in-hospital patients were visited once or more during the first 48 hours and asked about side-effects e.g. PDPH. Outpatients older than 60 years were interviewed by a telephone call on the third day after surgery. The younger ones were asked to send back a questionnaire free of charge. RESULTS: None of the 206 patients (mean age 30.7 years) who underwent caesarian sectio suffered from headache. Lower back pain was seldom [8] and moderate. They all had the bladder drained as a routine measure of the obstetrician. 547 of 600 in hospital patients were mobilized as soon as the block disappeared. 11 complained of headache. (1.8%) 2 females needed oral non-opioid analgesics, one 17-year-old woman an epidural blood patch (0.17%). 150 of the outpatients younger than 60 years sent back the questionnaire spontaneously. 75 had to be reminded by a telephone call. 10 of these 225 had PDPH but only 2 females needed oral non-opioids for one day. One 34-year-old woman needed conservative treatment with oral fluid intake more than 3 liters a day, analgesics and bed rest. None of the outpatients older than 60 years complained of headache. Two suffered from vomiting on the way home. Three males had disturbed bladder function, but did not need catheterism. CONCLUSIONS: The use of a thin pencil point needle (Whitacre G27) enables the application of a spinal anaesthesia to young people with a low risk of moderate PDPH. Pregnancy is not a contraindication. Early mobilisation does not increase the risk of PDPH even in young patients nor is this the case in outpatients. In outpatients older than 60 years a G26 Quinke needle, which is easier to handle and cheaper, is suitable for spinal anaesthesia without a risk of PDPH. Better post-operative vigilance may be a further benefit of the method. Young people especially appreciated the option to pursue their own video-endoscopic surgery. In a comparable group where an epidural was performed we found more side-effects.

Adult↗

PubMed1997

[Propofol and postoperative nausea and/or vomiting].

UNLABELLED: The objective of this prospective, randomised study was to investigate the incidence of postoperative nausea and/or vomiting (PONV) during the first 24 h postoperatively. For a quality assurance study on PONV, we compared two established general anaesthetic procedures in 239 patients undergoing four different types of surgery (subtotal thyroidectomy, laparotomy for gynaecological procedures, laparoscopy, and surgery for extra-abdominal procedures). METHODS: All eligible patients provided informed consent. For premedication temazepam 10-20 mg was administered orally. We used propofol (1.5-2 mg/kg) for induction of anaesthesia in all patients, followed by 0.1-0.3 mg fentanyl, 2.5-5 mg droperidol, and for muscular relaxation atracurium or pancuronium according to body weight. Maintenance of general anaesthesia in group A was by administration of isoflurane in a maximum concentration of 0.6 vol.% in 70% nitrous oxide and 30% oxygen and in group B by continuous infusion of propofol (5-8 mg/kg.h) and normoventilation with oxygen in air (Fi02 = 0.3). In both groups additional analgesia was provided intraoperatively by equal dosages of fentanyl up to a maximum of 0.6 mg and clonidine up to 200 micrograms. Episodes of PONV were registered following extubation, during the first 4 h postoperatively, during the period 4-24 h postoperatively, and after the first mobilisation. Pain scores were recorded with the aid of a visual analogues scale. The statistical evaluation was performed using the chi-square or Wilcoxon test. RESULTS AND DISCUSSION: In patients undergoing thyroidectomy or laparotomy, continuous infusion of propofol drastically reduced the incidence of PONV in the first 24 h postoperatively, particularly during the first 4 h (25/41 vs 10/41, resp. 20/32 vs 11/31). The overall incidence of PONV was higher in the first half of the menstrual cycles decreased with patient age, increased with the duration of anaesthesia, and was higher in patients with a history of motion sickness. With the same level of analgesia in both groups, the differences disappeared in the further postoperative course. The use of similar dosages of opioids for pain control in these groups might explain this observation. PONV occurred extremely rarely in patients undergoing laparoscopy (1 resp. 2 of 34), and in those undergoing surgery for extra-abdominal procedures did not occur at all. The explanation may be that the induction of anaesthesia with propofol was followed only by a relatively short duration of general anaesthesia for these surgical procedures, and postoperative pain control was performed solely with non-opioids. CONCLUSIONS: We found that the antiemetic effect of propofol was considerable in the early postoperative period. The higher cost of propofol as compared to other induction agents can be covered by not using nitrous oxide for maintenance of anaesthesia and by the decreased need for antiemetic drugs postoperatively. According to the calculations of our clinical pharmacy, the costs of the propofol infusion regimen exceeded those of balanced anaesthesia by 8.50 DM/h; the need for antiemetics was one-half that of the non-propofol group. Considering a cost of 16 DM for cleaning the bed after vomiting, improvement of the patient's condition during the postoperative period can be achieved without additional expense.

Adult↗

PubMed1984

[Clinical experiences with the short-acting opioid alfentanil (Rapifen)].

Alfentanil (R 39 209, Rapifen), a new short-acting narcotic analgesic, has been used in five modifications of routine anaesthesia. The results of these observations are discussed, as well as the haemodynamic and pharmacokinetic data reported in literature. Rapid onset and short duration of action due to a short elimination half-life time and a low distribution volume offer new possibilities in anaesthesiology. In premedicated patients the drug provides analgesia for very short lasting procedures and can supplement hypnotics like etomidate, short-acting barbiturates and benzodiazepines, e.g. midazolam. Thus it becomes possible to obtain a very pleasant anaesthesia under controlled or assisted ventilation with nitrous oxide/oxygen for procedures of a short or mean duration without further need for volatile anaesthetics.

Adjuvants, Anesthesia↗

PubMed1982

[Acute lung failure after tocolysis].

A case of severe respiratory distress syndrome in a healthy young woman is reported which occurred after administration of fenoterol during therapy for premature labour. The pathomechanisms are discussed in accordance with experimental data and case reports in the literature.

Adult↗

PubMed1976

[Demonstration total brain infarct with radioisotope angiography].

In the field of organ transplantation and in brain death patients where intensive-care measures may seem superfluous, the demonstration of cessation of cerebral blood flow by X-ray angiography is generally agreed to be the diagnostic procedure of choice to prove irreversible loss of cerebral function. There are, however, certain drawbacks involved in X-ray angiography. Arterial puncture is necessary. Furthermore, the procedure can be time-consuming, thus making the continuation of adequate intensive-care measures more difficult. At the same time the circulatory condition may worsen causing hypoxic damage to the organ to be transplanted. In the present paper, the authors report on 13 patients with clinical signs of brain death where cessation of cerebral blood flow was demonstrated atraumatically by intravenous radioisotope angiography (RIA) using a multicrystal gammacamera (Baird Atomic) and the bolus-injection technique with 99m Tc-pertechnetate. Nine patients had severe brain injuries, 2 patients had brain tumours, 1 patient had encephalitis and 1 patient had suffered prepartal thrombosis of the sinus sagittalis. In all patients EEG recordings were isoelectric. At the time when the RIA was performed systolic blood pressure had decreased to 62-85 mmHg (x = 71 mmHg), while body temperature had declined to 31-36,5 degrees C (x = 34 degrees). According to the present results, which were all confirmed by subsequent bilateral carotid X-ray angiography, total brain infarction is unequivocal when the following criteria are satisfied using RIA: 1. when the radioisotope bolus flows along the common carotid arteries but does not proceed any further than to the base of the skull or around the scalp structures, 2. when, at the moment when the radioactivity outlines the scalp structures, neither the intracranial arteries nor the capillary bed or the venous sinuses are visible, 3. when the time-activity curves across the hemispheres show simply a plateau of low count rate without the activity peak typical for cerebral tracer circulation and 4. when the activity peak, typical for venous outflow, is missing from the time-activity curves for the cervical areas. In 12 patients with extremely reduced cerebral blood flow it was demonstrated that the RIA findings were clearly different from those obtained at brain death. Moreover, not one of 438 other patients undergoing RIA exhibited the same features which were associated with brain death. The authors conclude that RIA involves the same degree of safety as X-ray angiography in the diagnosis of total brain infarction but is superior to the latter when the diagnostic procedure has to be performed quickly, thus reducing the risk of any further damage to a prospective donor organ.

Adolescent↗

PubMed1973