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Biomedical subjects

M Sold

Publications and source records attributed to M Sold.

32 records · Page 2Linked to original sources
PubMed1989

[Central venous catheterization with an incorporated J-wire and contamination protective sleeves for rapid venous catheterization of the external jugular vein].

The external jugular vein can easily be identified in most patients and provides an alternative access to the superior vena cava. Unfortunately, advancement of the catheter may be hampered for anatomical reasons, e.g. the presence of valves. Use of a flexible guide-wire with curved tip (J-wire), as first proposed by Blitt et al., results in a significant increase in the rate of successful cannulations. This method necessitates tedious surgical draping, however, that may not always be practicable. Therefore, a catheter was developed that is wrapped in a protective sleeve and contains a J-wire instead of the common plastic mandrin, thus making contamination during insertion impossible.

Catheterization, Central Venous↗
PubMed1987

[Antagonism of an intubation dose of vecuronium].

To study the problem of rapid antagonization of an intubation dose of vecuronium (0.08 mg/kg), 36 surgical patients undergoing barbiturate/halothane anesthesia were given edrophonium 0.5, 0.75, and 1.0 mg/kg or neostigmine 0.04, 0.06, and 0.08 mg/kg precisely 5 min following injection of the muscle relaxant. T1 twitch (T1/Tc) and train-of-four (TOF) ratios (T4/T1) of the hypothenar muscle were monitored every 20 s with the aid of a commercially available EMG monitor (Datex-Relaxograph). As documented by T1 and T4/T1 follow-up curves (Figs. 1 and 2) and derived parameters of relaxation as well (Dur25, Dur50, Dur75, recovery index, and reversal time; Table 4), both edrophonium and neostigmine resulted in a significantly shorter duration of vecuronium blockade (P less than 0.001). The mean time for recovery of TOF ratio to above 0.7 was between 10.8 +/- 6.0 (neostigmine 0.08 mg/kg) and 21.2 +/- 7.8 (neostigmine 0.06 mg/kg) min (mean +/- SD) following injection of the antagonist as compared to 58 +/- 18.4 min in the control group (P less than 0.001). Recurarization did not occur. Differences between drugs and dose-dependent effects were minimal; edrophonium did not prove superior to neostigmine with the exception of less pronounced muscarinic side effects, hence less bradycardia and a minimum heart rate of 57 +/- 8.2 bpm 20 min after the injection of neostigmine as opposed to 72 +/- 8.2 bpm following edrophonium (P less than 0.05; Fig. 4). As to the restitution of a ventilatory force sufficient to allow spontaneous breathing, no definite conclusions can be made.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1987

Alfentanil or fentanyl for anaesthetic procedures of two hours duration? A double-blind study.

Eighty women undergoing surgery of at least 2-h duration were randomly allocated to receive either alfentanil or fentanyl to supplement a diazepam nitrous oxide/oxygen anaesthetic. Anaesthesia was induced with fentanyl 0.2 mg and diazepam 10-20 mg and continued with nitrous oxide/oxygen. Analgesia was provided by injection of the narcotic using unlabelled ampoules that contained either alfentanil 0.5 mg ml-1 or fentanyl 0.05 mg ml-1. Apart from a marginally higher heart rate when alfentanil was used, there was no significant difference between groups at any time during the operation. Patients woke 2.7 +/- 3.1 min following discontinuation of nitrous oxide and were extubated after 10.3 +/- 7.6 min (alfentanil) and 17.3 +/- 19.0 min (fentanyl) (P = 0.1). However, following alfentanil significantly more patients could be extubated within 20 min to 30 min after completion of the operation (P less than 0.01). The last top-up dose of alfentanil had to be given nearer the end of the operation than the last dose of fentanyl (P less than 0.01). Patients receiving alfentanil needed significantly more (P less than 0.01) post-operative analgesia.

Adjuvants, Anesthesia↗
PubMed1986

Successful management of dissection of the aortic root during aortic valve replacement.

We present a case of intraoperative dissection of the aortic root in a patient with non-calcified aortic valve incompetence. This complication led to life-threatening bleeding from the dissection line into the layers of the left ventricle as well as the aortic wall with formation of an increasing subadventitial hematoma. The only possible management was to remove the valve prosthesis and to close the entry site of the dissection when reinserting the valve implant. The mechanism of this complication is discussed.

Aortic Dissection↗
PubMed1986

[Symptoms of acute cerebral hernia following induction of anesthesia in hydrocephalus--malignant hyperthermia in reality].

We report the case of a 4.9-year-old boy with congenital hydrocephalus and obstruction of his shunt who just after the induction of anaesthesia suddenly developed generalized muscle rigidity that made intubation impossible. Because of temporary mydriasis the situation could hardly be differentiated from acute cerebral herniation. The lack of any decrease in muscle tone after emergency trephination and drainage of the right lateral ventricle and the immediate improvement following intravenous dantrolene left no doubt about the diagnosis of malignant hyperthermia. The diagnosis was confirmed by the increase in serum creatine phosphokinase and the documentation of massive myoglobinuria. Reconstruction of the course of the first anaesthetic necessary for shunt implantation at the age of 62 days revealed that the same symptoms already had occurred. However, they then were not attributed to malignant hyperthermia but interpreted as symptoms of acute herniation. A detailed description of this first anaesthetic is given which again elucidates the problems associated with the abrupt onset of muscular hypertonus in a patient with neurologic disorder; moreover this may well be the first published case report of malignant hyperthermia at the age of just 2 months.

Anesthesia, General↗
PubMed1985

[Etomidate versus methohexital for intravenous anesthesia with alfentanyl and nitrous oxide-oxygen. A double-blind study of circulatory behavior and postoperative course].

This study compared both etomidate and methohexitone for intravenous anaesthesia with alfentanil and nitrous oxide/oxygen in 2 X 20 patients scheduled for ENT-surgery, in a double blind, random fashion. Apart from the alternative use of etomidate and methohexitone the anaesthetic procedure did not differ: After a small dose of alfentanil anaesthesia was induced by a bolus dose of the hypnotic followed by a continuous infusion of the drug. In case of inadequate analgesia alfentanil was injected. This technique provided a good quality of anaesthesia and a remarkable cardiovascular stability. Critical arterial pressures or heart rates never occurred. During the operation patients receiving etomidate exhibited a moderate rise in blood pressure and a significantly lower heart rate than patients anaesthetised with methohexitone. After some 90 min of anaesthesia patients awoke on the average 7 min after the end of the operation and could be extubated at once. During the first three postoperative hours there was no difference in recovery between groups. Whereas half an hour postoperatively the capacity of immediate memory was limited to 44 bit following etomidate and 48 bit following methohexitone, i.e. to 47 and 54% of its normal capacity, there was only a minimum but significant impairment of cerebral function after 3 h. There was no difference in the need for alfentanil. The dosage of etomidate and methohexitone was lowe than that reported in the literature. It proved to be impossible for the anaesthetist to decide which drug he was using. Hence both anaesthetic techniques compare favourably with each other.

Adolescent↗
PubMed1985

[Life-threatening anaphylactoid reaction following etomidate].

In a patient scheduled for coronary artery bypass grafting induction of anaesthesia resulted in a life-threatening anaphylactoid reaction with development of an erythema of the neck. Severity and duration of hypotension and tachycardia were such as to require intensive management and postponement of surgery. Skin tests ruled out any other cause except etomidate. Hence for definite surgery exactly the same induction manoeuvre was chosen, but etomidate was omitted. Anaesthesia and surgery proceeded completely uneventfully. There can be no doubt that this anaphylactoid reaction (grade III according to the classification proposed by Lorenz and Doenicke) was caused by etomidate.

Anaphylaxis↗
PubMed1983

[Effect of fentanyl, diazepam and flunitrazepam on memory function. A pharmacopsychologic study].

This study was designed to differentiate possible amnesic effects of diazepam, flunitrazepam and fentanyl into impairment of storage, retention or retrieval of information and to correlate them with alterations in a vigilance task. 4 groups of 7 volunteers each were studied in a double-blind, random fashion. They performed a quasi continuous word recognition task i.e. after a preload list of 150 words played on a tape they had to indicate if the following words (grouped into 10 blocks of 100 words each) were new ones or had occurred already. Interposed were measurements of reaction time to a visual stimulus, and of concentration and short-time memory. During the experiment, unknown to the test person, diazepam 10 mg/70 kg, flunitrazepam 1 mg/70 kg, fentanyl 0.15 mg/70 kg or placebo were infused over 3 min. For evaluation of the word recognition task the d' index drawn from signal detection theory was employed. The results clearly indicated that both benzodiazepines specifically impair memory function the effect of flunitrazepam being more pronounced and longer in duration. Since retrieval of information learnt before administration of either drug was completely unaffected it was concluded that both drugs specifically influence encoding and registration of information. Reaction times were not significantly altered after diazepam, whereas they were prolonged by more than 50% after flunitrazepam indicating a pronounced sedative action of this drug. However, even during this period of maximal effect of flunitrazepam, recognition of words first presented prior to injection was not impaired.(ABSTRACT TRUNCATED AT 250 WORDS)

Diazepam↗
PubMed1982

[Recovery from anesthesia with enflurane and neuroleptanesthesia. Quantitative assessment with the aid of psychopathometric tests].

Methodological differences between techniques used to examine recovery from anesthesia prevent direct comparison of results. Also psychological tests are not validated for certain anaesthesiological considerations. The two tests presented here combine ease of use for a bedside test with the advantage that the results are expressed as absolute values of cerebral depression. Based on Wieck's concept of symptomatic or functional psychosis they were developed to document the course of neuropsychiatric illness. Their application following anaesthesia seems to be justified as anaesthesia may be regarded as being a deliberately induced functional psychosis characterized by extremely compressed dynamics. The target of a first pilot study were 60 patients following neuroleptanalgesia with and without antagonization with naloxone, or enflurane anaesthesia, respectively. Psychopathometric evaluation yielded an obvious post-operational decline in the SKT-scores which clearly remained below the pre-operative values even after three hours. All the patients revealed a severe transient syndrome after thirty minutes, a moderate syndrome after one and two hours and a mild syndrome after three hours. The only exception were patients antagonized with naloxone who initially showed an improvement but who afterwards did not behave any better. Neither duration of anaesthesia nor total dose of drugs administered showed any significant correlation to the extent of postoperative cerebral depression. Being uninfluenced by moderating variables such as age and IQ, the psychopathometric tests presented here seem to provide a sensitive and reliable method for quantification of recovery from anaesthesia.

Adolescent↗