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M Wrobel

Publications and source records attributed to M Wrobel.

11 recordsLinked to original sources
PubMed2006

[Videolaryngoscopy versus direct laryngoscopy for elective endotracheal intubation].

BACKGROUND: We compared the ease of viewing the glottis under direct vision during conventional laryngoscopy with the quality of indirectly viewing on a monitor during laryngoscopy with a Macintosh videolaryngoscope in a multicenter study. PATIENTS AND METHODS: After ethical approval and written informed consent of 300 patients with no anticipated difficult airway, conventional laryngoscopy with a Macintosh videolaryngoscopy blade was performed and the quality of the view of the glottis was assessed and documented according to the Cormack and Lehane scoring system as modified by Yentis and Lee. Subsequently, the indirect viewing conditions on the monitor were documented without changing the position of the blade. Differences between both distributions were analyzed using the Bland-Altman Test. RESULTS: Videolaryngoscopy improved the laryngoscopy score by 1 grade in 72 cases, by 2 grades in 17 cases and by 3 grades in 2 cases. A relevant improvement (from grades III/IV to II) was found in 28 patients. Viewing conditions worsened in 3 cases by 1 grade, in 4 cases by 2 grades and in 3 cases by 3 grades. A statistical analysis of the data gave a bias of 0.31 and an SD bias of 0.77.The 95% confidence interval of the distribution ranged from -1.12 to 1.81. CONCLUSION: Videolaryngoscopy can lead to better viewing conditions but in rare cases it may result in worse viewing conditions.

Adult↗
PubMed2004

[Bispectral index and desflurane concentration below 1 MAC].

INTRODUCTION: We investigated the relationship between bispectral index (BIS, A-2000, Aspect Medical Systems, USA) and end-tidal desflurane concentrations below 1 MAC which is especially the range of interest if desflurane is combined with remifentanil for fast-track anaesthesia. METHODS: With institutional review board approval and written informed consent we investigated 50 adult ASA I-III patients scheduled for minor orthopaedic surgical procedures. The BIS electrode (BIS-Sensor, Aspect Medical Systems, USA) was positioned on the patient's forehead as recommended by the manufacturer. All patients were premedicated with 0.15 mg x kg(-1) diazepam orally in the evening and on the morning before surgery. Induction of anaesthesia was started with a remifentanil infusion at 0.4 micro g x kg(-1) x min(-1) and 5 min later 2 mg x kg(-1) propofol was given for hypnosis. Immediately after intubation, remifentanil was reduced to 0.2 micro g x kg(-1) x min(-1), and the depth of anaesthesia was adjusted according to clinical needs by regulating the desflurane concentration. Starting 20 min after induction, a total of 1,483 data pairs, i.e. end-tidal desflurane concentrations with corresponding BIS values, was recorded. During surgery data pairs were analysed by linear regression analysis for each patient separately. During emergence from anaesthesia, desflurane effect compartment concentrations were simulated and non-linear regression analysis was applied. RESULTS: We found a relationship between BIS ranges and mean end-tidal desflurane concentrations: A BIS range of 100-85 was related to 1.1+/-0.7 vol%, BIS 84-65 to 1.5+/-1.2 vol%, BIS 64-50 to 2.9+/-1.3 vol% and BIS 49-40 to 3.1+/-0.9 vol%. In particular, end-tidal desflurane concentrations related to these BIS ranges were significantly different from each other (ANOVA; P<0.05). Intraoperatively, we obtained a correlation coefficient of R=0.42+/-0.24 (mean+/-SD, range 0.05-0.96), during emergence from anaesthesia the correlation coefficient was R=0.84+/-0.12 (range 0.61-0.99). CONCLUSION: We could demonstrate a relationship between bispectral index and end-tidal desflurane concentrations below 1 MAC with a BIS range of 49-40 being associated with approximately 0.5 MAC of desflurane during desflurane-remifentanil-anaesthesia.

Adult↗
PubMed2004

[Laryngeal tube versus laryngeal mask airway in anaesthetised non-paralysed patientsA comparison of handling and postoperative morbidity].

BACKGROUND: The purpose of this study was to compare the classical laryngeal mask airway (LMA) with the laryngeal tube (LT) in anaesthetised non-paralysed patients. PATIENTS AND METHODS: A total of 100 patients scheduled for minor elective surgery were included. After standardised induction and maintenance of anaesthesia with propofol and remifentanil, patients were randomly allocated to receive either a LMA or LT; muscle relaxants were not applied. Selection of the appropriate size and the initial inflation volume were chosen according to the manufacturers instructions. Ease of insertion, initial intra-cuff pressure, oropharyngeal leak pressure at an intra-cuff pressure of 60 cm H(2)O and incidence and severity of complications during and after anaesthesia were compared. RESULTS: The LT was inserted significantly quicker than the LMA (35.1+/-15.9 s vs. 56.6+/-42.5 s; mean+/-SD). Insertion of the LT was successful within 1 attempt in 90% and within 2 or 3 attempts in another 4% of patients for the LT compared with 68% and 20% of patients for the LMA, respectively. For the LT the initial cuff pressure was significantly lower (75.1+/-16.2 cm H(2)O) and the oropharyngeal leak pressure after adjustment of the intra-cuff pressure to 60 cm H(2)O was significantly higher (27.2+/-6.9 mbar) compared with the LMA (109.5+/-25.7 cm H(2)O and 19.9+/-4.0 mbar, respectively). Incidence of postoperative laryngeal complications in the LT group (31%) was lower compared with the LMA group (54%). CONCLUSION: In anaesthetised non-paralysed patients the LT compares favourably to the LMA in terms of ease of insertion and postoperative morbidity.

Adult↗
PubMed2003

The concentrations of catecholamines and oxytocin receptors in the oviduct and its contractile activity in cows during the estrous cycle.

UNLABELLED: In vitro experiments on oviducts of cyclic cows were undertaken to study: (1) the content of dopamine (DA), noradrenaline (NA) and adrenaline (A) in infundibulum, ampulla and isthmus, (2) the concentration of oxytocin receptors (OTR) in oviductal tissues and (3) the motility of ampulla and isthmus. Changes of DA content were observed in the infundibulum and the ampulla with maximal values occurring on Days 6-10 of the estrous cycle. The mean NA content was greatest in infundibulum<ampulla<isthmus. NA concentrations were the highest in the isthmus on Days 1-5 and 16-21, whereas in infundibulum NA levels were low during the whole estrous cycle. Mean A content was the highest (P<0.001) in the isthmus and in the studied regions of the oviduct A content decreased from Days 1-5 to Days 16-21 (P<0.01). Oxytocin receptors densities were measured in oviducts collected from cows on Days 16-21 (277.1+/-151.4 fmol/mg protein; K(d) 20.5+/-10.9 nM). Oxytocin (10(-7) M) increased the area under the contractile curve (AUC) of the ampulla and the isthmus on Days 16-21 and of the isthmus on Days 1-5 (P<0.01). Acetylcholine (Ach) (10(-7) M) stimulated the ampulla and the isthmus contractions on Days 1-5 (P<0.05) and ampulla contractions on Days 6-10 and 16-21 (P<0.01). NA (10(-5) M) relaxed the ampulla and the isthmus during most of the studied days but was most effective on Days 1-5 and 16-21 (P<0.01). IN CONCLUSION: (a) catecholamine content in the bovine oviduct varies by region and phase of the estrous cycle, (b) the presence of OTR and the stimulatory effect of oxytocin on oviduct motility are evident in the follicular-phase cows, (c) Ach and NA modify contractile activity in the oviduct of cows during follicular and early-luteal phases and (d) the studied oviductal parameters did not differ by ipsilateral and contralateral relationships to the active ovary in cow.

Acetylcholine↗
PubMed2003

[Remifentanil. An update].

Remifentanil is a 4-anilidopiperidine mu-opioid analgesic which is rapidly metabolized by unspecific blood and tissue esterases. According to its unique pharmacokinetic profile, remifentanil-based anaesthesia combines high-dosage opioid analgesia intraoperatively with a rapid and predictable postoperative awakening. When compared with a standard fentanyl-based technique, the use of remifentanil has changed our present anaesthetic regimens. This includes the anaesthesia induction sequence, the choice and dosage of anaesthetics when used as adjuncts to remifentanil, and even more, the proper planning of postoperative pain management. The present paper was designed to review the current knowledge on remifentanil and all aspects of its use in anaesthesiology. In addition, present data on the use of remifentanil for analgesia and sedation of the critically ill patient are summarized.

Aging↗
PubMed2003

Effects of memantine, an NMDA receptor antagonist, on place preference conditioned with drug and nondrug reinforcers in mice.

Antagonists of the N-methyl-D-aspartate (NMDA) receptor complex have been shown to inhibit the expression of place preferences conditioned with several drugs that are abused by humans, which suggests that this class of compounds may be beneficial in the treatment of substance dependence. Therefore it is important to assess the specificity of this effect, of whether inhibitory effects of NMDA receptor antagonists on conditioned drug stimuli generalize to behaviors produced by nondrug reinforcers. The present study was designed to compare the effects of the NMDA receptor channel blocker, memantine, on the expression of place preferences conditioned with: (1) consumption of regular laboratory food; (2) sexual encounters with females; and (3) injection of morphine (10 mg/kg) in adult male Swiss mice. For all three experiments reported here, unconditioned stimuli (food, receptive female or morphine) were presented before the exposures to the "to-be-conditioned" environments. Significant place preferences developed as a result of explicit pairings of the environmental context and food consumption, sexual encounter and morphine administration. Memantine (7.5 mg/kg, given prior to the post-conditioning test) inhibited the expression of place preferences conditioned with morphine and sexual encounter, but had no effects in food-conditioned mice. These findings suggest that the effects of NMDA receptor blockade may not be limited to drug-reinforced behaviors.

Animals↗
PubMed2002

Significance of high and normal neonatal nucleated red blood cell count in small-for-gestational-age newborns.

The objective of this study was to evaluate the obstetrical and neonatal outcome in small-for-gestational age (SGA) and appropriate-for-gestational-age (AGA) fetuses with normal and elevated neonatal nucleated red blood cell counts. Therefore the nucleated red blood cell count was assessed immediately after birth in 906 neonates delivered at our institution and the perinatal and neonatal data were compared. Postnatally, infants were classified as SGA if they had a birth weight for given gestational age below the 10th percentile. Neonates were allocated to four groups according to their nucleated red blood cell count: SGA neonates with normal and high nucleated red blood cell count and appropriate-for-gestational-age newborns (AGA) with normal and high nucleated red blood cell count. Statistical analysis included the Mann-Whitney U-Test, Student's t-test, chi2 analysis of variance and stepwise regression analysis. SGA newborns with high nucleated red blood cell count had a significantly lower birth weight, a lower gestational age at delivery, lower arterial and venous pH values, lower Apgar scores at 1 min, 5 min and 10 min as well as lower base excess values compared to the other groups. They had to be transferred significantly more often and stayed longer in the neonatal intensive care unit. Three cases of intraventricular hemorrhage, four cases of necrotizing enterocolotis and two neonatal deaths occurred all in the SGA group with high neonatal nucleated red blood cell counts. Neonatal outcomes of SGA and AGA newborns with normal nucleated red blood cell counts were comparable. Our data do therefore underline the possible value of neonatal nucleated red blood cell counts to differentiate the healthy small-for-gestational age newborn from the truely growth retarded newborn.

Apgar Score↗
PubMed2000

Neonatal nucleated red blood cell counts in small-for-gestational-age fetuses: relationship to fetoplacental Doppler studies.

OBJECTIVE: To study the influence of pathologic umbilical and middle cerebral artery and uterine artery Doppler studies on the nucleated red blood cell count in small-for-gestational-age (SGA) fetuses. MATERIALS AND METHODS: Cord blood was prospectively collected during a 18-month period. 80 SGA fetuses (fetal abdominal circumference < 5th percentile) with Doppler ultrasound of the umbilical, the middle cerebral artery and both uterine arteries were enrolled in the study. SGA fetuses with normal Doppler flow velocity waveforms were allocated to group 1 (n = 23). Group 2 (n = 13) were fetuses with abnormal umbilical Doppler studies and group 3 (n = 44) were fetuses with both, pathologic umbilical and uterine artery Doppler studies. 2 fetuses in group 3 showed evidence of brain sparing, 3 fetuses presented absent-end-diastolic flow in the umbilical artery. Outcome measures included nucleated red blood cell count, Apgar scores, arterial pH and arterial base excess, venous pH, birth weight, gestational age at delivery, mode of delivery, rate of neonatal intensive care unit admission and length of stay in the neonatal intensive care unit. RESULTS: Highest nucleated red blood cell counts with lowest birth weight and gestational age were found in group 3. Decelerations of the fetal heart rate were more frequent in study group 3 and caesarean section for fetal indication was performed more often in this group. Those fetuses had to be transfered more often to the neonatal intensive care unit than fetuses of the other study groups. There was a tendency in group 3 towards lower arterial pH values and arterial base excess values. Fetuses with absent-end-diastolic flow in the umbilical artery presented highest nucleated red blood cell counts. CONCLUSION: In SGA fetuses increasing Doppler pathology seems to be correlated with increasing nucleated red blood cell count post-partum. Pathologic uterine artery flow results might have an additional impact on the number of nucleated red blood cells at birth.

Apgar Score↗
PubMed2000

Nucleated red blood cell count and doppler ultrasound in low- and high-risk pregnancies.

OBJECTIVE: The aim of this study was to evaluate the influence of circulatory deterioration in small-for-gestational-age fetuses (SGA) on the nucleated red blood cell count (NRBC). PATIENTS AND METHODS: During a 12-month period 194 patients with a complete NRBC count post-partum were enrolled in the study. Using pulsed wave colour Doppler ultrasound we recorded blood flow velocity waveforms from both uterine arteries and from the umbilical artery and/or from the fetal aorta. Patients were assigned to seven groups according to the results of the Doppler examination. Mean outcome measures were birthweight, gestational age at delivery, NRBC count, incidence of preeclampsia or SGA and need of neonatal intensive care. RESULTS: Significantly higher nucleated red blood cell counts than in all other groups were found in cases with abnormal Doppler findings in both uterine arteries and the umbilical artery and/or fetal aorta (p<0.001). These newborns had significantly lower birth weights (p<0.01, p<0.001), lower gestational age (p<0.001), an increased likelihood of caesarean section for clinical signs of fetal distress (p<0.001) and had to be transfered more frequently to the neonatal intensive care unit (p<0.01, p<0.001). CONCLUSION: Patients with abnormal Doppler velocimetry waveforms of the uterine arteries in the presence of an abnormal umbilical artery or fetal aorta Doppler findings have a high risk of prematurity, preeclampsia or delivering a small-for-gestational-age newborn. Fetal response to uteroplacental insufficiency may lead to elevated nucleated red blood cells in the fetal blood. This fact might help to discriminate the small-for-gestational-age fetus who is growth-retarded and suffers from chronic placental insufficiency from the small but healthy fetus.

Birth Weight↗
PubMed1999

Nucleated red blood cells in cord blood of singleton term and post-term neonates.

OBJECTIVE: This study aims to determine if nucleated red blood cells are elevated in pregnancies that continue beyond 289 days of gestation. STUDY DESIGN: Cord blood was prospectively collected from term and post-term singleton gestations from August 1 to December 31, 1998. Umbilical artery nucleated red blood cells were counted per 100 white blood cells. The comparison was made between pregnancies ending at 261-289 days (37.1-41.2 weeks) of gestation and those ending after 289 days (> or = 41.3 weeks) of gestation. RESULTS: Cord blood from 304 cases was obtained and evaluated for nucleated red blood cells per 100 white blood cells. The mean value of nucleated red blood cells per 100 white blood cells in the post-term neonate group was significantly higher than in the term neonate group (median 6.5, range 0-24 vs. median 3.7, range 0-14; p < 0.05). The values did not vary by fetal presentation, mode or duration of delivery. Neonatal outcome was comparable between both study groups. CONCLUSION: In post-term gestation after 289 days nucleated red blood cells in cord blood are significantly increased. These results point towards a different fetal oxygenation in post-term pregnancies beyond 289 days of gestation and support the current practice of very close testing of fetal well-being under those circumstances.

Apgar Score↗