Biomedical subjects

M Könen-Bergmann

Publications and source records attributed to M Könen-Bergmann.

3 recordsLinked to original sources

PubMed2001

Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index.

STUDY OBJECTIVE: To identify and quantify the interaction between propofol and remifentanil during surgical procedures with a bispectral index (BIS) of 50 that was chosen as a continuous surrogate measure for "adequate depth" of anesthesia. DESIGN: Prospective, open-label study. SETTING: Department of orthopedics of a university hospital. PATIENTS: 20 patients undergoing orthopedic surgery. INTERVENTIONS: Anesthesia was induced and maintained with propofol and remifentanil, both administered by target-controlled infusion (TCI). Initial target concentrations of propofol (1.5-8 microg/mL) and remifentanil (2-15 ng/mL) were chosen and alternated in order to maintain the BIS between 45 and 55. If constant target concentrations had been maintained for 20 minutes and the BIS did not depart from the desired range, blood samples were taken to determine propofol concentrations, and the BIS value was recorded. Isobolographic interaction models were fitted to the infusion rates of remifentanil and propofol, predicted target concentrations of both drugs, and measured propofol concentrations versus predicted remifentanil concentrations. MAIN RESULTS: The isobole for the interaction of propofol and remifentanil in the concentration range investigated (propofol 1.5-8 microg/mL and remifentanil 1-30 ng/mL) is a concave up hyperbola ((0.15. C(prop))(3.13). C(rem) = 1) with C(prop) = propofol plasma concentration [microg/mL] and C(rem) = remifentanil blood concentration [ng/mL]). Use of predicted (=TCI target) concentrations or the respective infusion rates did not alter the general shape of the interaction isobole. CONCLUSIONS: The interaction between propofol and remifentanil for maintenance of a BIS value between 45 and 55 during surgery is synergistic. This finding applies regardless of whether measured concentrations (for propofol), predicted concentrations of the infusion device, or infusion rates are used as model input. Notably, the interaction isobole of the (clinically readily available) infusion rates provides a useful dosing recommendation for the coadministration of propofol and remifentanil during maintenance of anesthesia.

Adult↗

PubMed1999

An algebraic solution to dead space determination according to Fowler's graphical method.

According to Fowler's method, anatomical dead space (VD) can be determined graphically or computer-aided by iteration procedures by which phase III of a fraction-volume expirogram F(V) is back-extrapolated by a straight line R(V). Whereas Fowler visually partitioned phase II into two equal areas bordered by F(V), R(V), and VD, in the present paper the area between F(V) and R(V) is set equal to the area of a trapezoid, one side of which is the unknown VD to be determined. We obtained two algebraic equations for both possible conditions, nonsloping and sloping alveolar plateau, and, as the main result, an even more general third equation that includes both Bohr's and Fowler's solution. The formulas exactly represent Fowler's graphical method and can be applied to all gases which are applicable in dead space determination. The derived equations were tested in experimental situations, showing equality between values of dead space determined by using the algebraic solution and the graphical method. Their major advantage is facilitating and speeding up computer-aided on-line determinations of VD.

Algorithms↗

PubMed1998

Decreasing diffusion limitation on exercise in lower-graded interstitial lung disease.

In this study we investigated the contribution of diffusion limitation to the exercise-induced hypoxaemia in interstitial lung disease (ILD). We applied isotopic analysis to the composition of the stable isotopic oxygen molecules 16O2 and 16O18O in expiratory gas mixtures obtained from six ILD patients and six healthy subjects at rest and during ergometer work (60 W). The changes in the 16O18O/16O2 ratios were interpreted by using the overall fractionation factor of respiration (alpha O) which would be increased towards 1.03 on increasing diffusion limitation. In addition, the O2 partial pressures of alveolar gas and arterial blood (PAO2, PaO2) were determined. In the patients, alpha O was significantly reduced from 1.0066 +/- 0.0004 (mean +/- SD) at rest to 1.0035 +/- 0.0004 during exercise and in the healthy subjects from 1.0072 +/- 0.0008 to 1.0044 +/- 0.0004. Furthermore, the exercise-induced reduction of PaO2 (from 77 to 69 mmHg) was due to a drop of alveolar PO2 found in each patient, whereas in each healthy subject PaO2 was increased on exercise. On the basis of a resistance model we conclude that the patients' data were inconsistent with increasing diffusion limitation but showed an increasing impairment of O2 transport by ventilation.

Arteries↗