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Biomedical subjects

M Jöhr

Publications and source records attributed to M Jöhr.

At least 19 recordsLinked to original sources
PubMed2003

Cardiac arrest in an infant with congenital adrenal hyperplasia.

We report a 3-month-old boy who suffered an out-of-hospital cardiac arrest. During resuscitation, the medical team was informed that he was receiving hydrocortisone treatment. The possibility of adrenal insufficiency with hyperkalemic cardiac arrest prompted the administration of calcium, which resulted in the return of spontaneous circulation. The infant's diagnosis of congenital adrenal hyperplasia was not spontaneously mentioned by the parents. This case illustrates the importance of obtaining adequate parental information and considering hyperkalemia as a possible cause of cardiac arrest.

Adrenal Hyperplasia, Congenital↗
PubMed2003

[Regional anesthesia in newborn infants, infants and children--what prerequisites must be met?].

UNLABELLED: In general, every anaesthetic technique should only be used with a given indication after a careful risk-benefit evaluation, when there are no contraindications and when the physician has sufficient knowledge and skill to safely perform the technique. INDICATION: the great advantage of regional blocks is that they can be administered without the risks of opioids, e.g. respiratory depression, nausea, vomiting and delayed gastric emptying. Regional anaesthesia is rarely indicated instead of general anaesthesia: even ex-premature babies can safely undergo general anaesthesia supplemented with a regional block. Special risks occur when regional blocks are performed in anaesthetised children, and special care is needed. However, in contrast to adult practice, this is a generally accepted modality of paediatric anaesthesia worldwide. In addition, perfect analgesia may obscure the signs of compartment syndrome and beginning pressure sores. Preoperative evaluation: the preoperative evaluation relies mainly on the patient's history. Coagulation tests are not performed as routine screening. However, even with a careful history, bleeding disorders can be overlooked, especially in neonates and infants. Mastering the technique: caudal anaesthesia can be used for a large variety of interventions below the umbilicus; therefore, a sufficient caseload can be achieved by most anaesthetists, and the technique can be easily learned. It should belong, together with wound infiltration, ilioinguinal and penile block, to the armamentarium of all anaesthetists caring for children. However, regional blocks are of limited duration and are therefore only part of a concept of balanced analgesia, which also involves nonsteroidals, paracetamol and opioids.

Analgesia, Epidural↗
PubMed2002

[Succinylcholine--update].

The action profile of succinylcholine is unmatched even 50 years after its introduction into anaesthestic practice. This is probably why succinylcholine, despite its many and partly life-threatening side-effects, is still considered to be indispensable by many anaesthetists and emergency doctors. The main indication for succinylcholine--the facilitation of endotracheal intubation in patients considered to be at an increased risk of aspiration of gastric fluid, e.g. patients undergoing a Caesarean section or presenting with an ileus--remains undisputed. Some of the side-effects of succinylcholine can be diminished by precurarisation. However, just like priming, this technique holds some considerable dangers (such as a clinically significant attenuation of the protective reflexes) and has become a matter of increasing controversy. Rocuronium (> or = 1 mg/kg) is currently the best alternative to succinylcholine for rapid sequence induction. The routine use of succinylcholine as a relaxant for intubation is questionable, mainly because there are a number of modern anaesthetic techniques (laryngeal mask airway) and new drugs (rocuronium, mivacurium, remifentanil) which make succinylcholine quite dispensable except for a few situations (e.g. re-positioning of fractures). In the case of an expected difficult airway no muscle relaxant should be given, because severe hypoxaemia in these patients probably can only be prevented by a professional airway management. Succinylcholine is no longer an option in elective paediatric anaesthesia. The drug, however, retains its value in critical situations where a rapid onset but a short duration of action is of prime importance.

Animals↗
PubMed2001

[Tracheal rupture: delayed diagnosis with endobronchial intubation].

Tracheobroncheal rupture is a rare complication of intubation techniques using a stylet. In this case report the patient was intubated by an emergency physician in a preclinical setting after a motor vehicle accident. Iatrogenic tracheal laceration was masked by inappropriate position of the endobronchial tube. By chance ventilation was maintained to both lungs by flow through the Murphy's eye of the tube and the lumen of the tube. In correcting the deep tube position after a chest x-ray laceration of the trachea was unmasked and ventilation problems occurred immediately. The tube was replaced under fiberoptical control and the patient was managed for surgical repair using a jet ventilation technique. In this case two complications of endobronchial intubation occurred, but the deep tube placement opposed the effects of the tracheal laceration. This was probably life saving for the patient during emergency transfer by helicopter after the accident. The anaesthesiological management during tracheal repair is discussed.

Accidents, Traffic↗
PubMed2001

[Postpartum neurologic complications following delivery with peridural analgesia. Case report with literature review].

Regional analgesia provides effective pain relief during delivery. Postpartal neurological deficits may be due to pressure of the fetal head on nerve structures at the pelvic rim or may be a complication of epidural analgesia. Nerve injuries due to spontaneous delivery and instrumental delivery are much more common than neurological deficits from epidural analgesia such as epidural hematoma or epidural abscess. The pattern of nerve damage is usually unilateral and non segmental. This case report describes the differential diagnosis of neurological deficit after spontaneous delivery under epidural analgesia and a discussion of the recent literature. Finally recommendations for the treatment of neurological deficits after delivery under epidural analgesia are presented.

Adult↗
PubMed1998

Blockade of the sciatic nerve in the popliteal fossa: a system for standardization in children.

UNLABELLED: The sciatic nerve can be blocked at different levels, providing excellent surgical and postoperative anesthesia and analgesia. We report a series of 50 blocks performed via the popliteal fossa in children. Localization of either the tibial or peroneal nerve was facilitated by a nerve stimulator. The local anesthetic solution was injected at the point where nerve stimulation was achieved with 0.4 mA at an impulse width of 1.0 ms. The depth of insertion of the stimulation cannula correlated with the age, weight, and height of the patients. The best predictor for depth of insertion was the patient's weight. The minimal depth of insertion was 13 mm. No failure of blockade was seen in this case series. Blockade of the sciatic nerve can easily be performed in the popliteal fossa even in small children. IMPLICATIONS: Blockade of the sciatic nerve can easily be performed in the popliteal fossa even in small children. The depth of insertion of the stimulation cannula can best be estimated according to the weight of the patient. The minimal depth required was 13 mm.

Adolescent↗
PubMed1997

[Acute lumbar disk displacement with nerve root compression. Indications for peridural steroid injection].

The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.

Acute Disease↗
PubMed1996

[Value of monitoring muscle relaxation].

INDICATION: Sensitivity to neuromuscular blocking agents differs between individuals, and residual neuromuscular blockade is a common postoperative problem. Clinical signs such as head lift, hand grip, and inspiratory force are suitable means of showing residual blockade. However, an awake and cooperative patient is needed. Therefore, in clinical practice it is advantageous to use the responses evoked by a nerve stimulator. SITES OF NERVE STIMULATION AND DIFFERING MUSCLE RESPONSE: In clinical anesthesia, the ulnar nerve is the most popular site. The response is evaluated by feeling the contractions of the adductor pollicis muscle. This muscle shows a slow onset of blockade and is highly sensitive to neuromuscular blocking agents. Therefore, the chance of overdosing the patient is decreased and during recovery additional safety is gained, as it can be safely assumed that at the time of normalization of the thumb twitches no residual blockade exists in the diaphragm or larynx. On the other hand, absent twitches of the adductor pollicis using train-of-four stimulation do not preclude intraoperative activity of more resistant muscles such as the diaphragm. RECORDING OF EVOKED RESPONSES AND PATTERNS OF NERVE STIMULATION: In clinical anesthesia, tactile evaluation of the muscle response is the usual method. Mechanomyography (Myograph) with a force transducer is used as the reference standard. This method, as well as the measurement of acceleration (Accelograph, TOF-Guard) and electromyography (Relaxograph) are mainly tools for teaching and research. Different patterns of nerve stimulation are used: during induction, single-twitch stimulation at 1Hz; during profound blockade, post-tetanic count stimulation (PTC); surgical blockade is evaluated using train-of-four stimulation (TOF); and recovery is followed by double-burst stimulation (DBS). Using simple train-of-four stimulation during recovery, a device is needed with a registering capacity to accurately determine a TOF-ratio > 0.7. CONCLUSIONS: Relaxometry allows monitoring of neuromuscular function independently of the patient's cooperation, and should be standard. In the intensive care unit, relaxometry helps to minimize the risk of overdosing. However, muscular weakness can persist despite adequate drug dosage. Relaxometry is only part one of a concept. Intubating and operating conditions are highly dependent on the depth of anesthesia, and the risk of postoperative residual blockade can be minimized by using short or medium action drugs.

Electric Stimulation↗