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Biomedical subjects

P W Kranner

Publications and source records attributed to P W Kranner.

9 recordsLinked to original sources
PubMed1999

Wire-guided endobronchial blockade in a patient with a limited mouth opening.

PURPOSE: We report the use of wire-guided endobronchial blockade, a new method of achieving one-lung ventilation, in a patient requiring awake, nasal, fibreoptic intubation for resection of a lung carcinoma. CLINICAL REPORT: A 43-yr-old woman with limited mouth opening, from severe TMJ dysfunction, required a right thoracotomy for right upper lobe wedge resection. One-lung ventilation was accomplished using a new type of wire-guided endobronchial blocker. The device was placed coaxially through the endotracheal tube using a pediatric bronchoscope through a special bronchoscopy port. CONCLUSION: Effective one-lung ventilation was achieved using this system. The system may prove advantageous in clinical situations where placement of double lumen endotracheal tubes or Univent tubes is technically impractical or impossible.

Adult↗
PubMed1999

One-lung ventilation when intubation is difficult--presentation of a new endobronchial blocker.

BACKGROUND: One-lung ventilation utilizing a double-lumen endotracheal tube may be technically difficult or inappropriate in morbidly obese or critically ill patients. In patients requiring awake fiberoptic intubation, double-lumen tube placement may be impossible. Wire-guided endobronchial blockade through a conventional endotracheal tube is a new alternative for these patients. METHODS: A 44-year-old, 133 kg female patient was scheduled to undergo a thoracotomy for transthoracic fundoplication. A wire-guided endobronchial blocker (WEB) was placed following rapid-sequence induction and intubation with an 8.0 OD single-lumen endotracheal tube with the aid of a pediatric bronchoscope. RESULTS: The WEB, using a guiding loop, was placed with ease and allowed effective one-lung ventilation. CONCLUSION: The WEB system allows one-lung ventilation to be achieved with a conventional endotracheal tube. The need for reintubation at the end of surgery is eliminated and endotracheal tube cross-sectional area is conserved.

Adult↗
PubMed1998

Cardiac function is a risk factor for paralysis in thoracoabdominal aortic replacement.

PURPOSE: We studied factors that influence paralysis risk, renal function, and mortality in thoracoabdominal aortic replacement. METHODS: We prospectively collected preoperative demographic and intraoperative physiologic data and used univariate and multivariate analyses to correlate this data with risk factors for paralysis. A mathematical model of paraplegia risk was used to study the efficacy of paraplegia reduction strategies. We analyzed preoperative and operative factors for paralysis risk, renal function, and mortality for 217 consecutive patients surgically treated from 1984 through 1996 for 176 thoracoabdominal and 41 thoracic aneurysms at the University of Wisconsin Hospital and Clinics. No patient had intercostal reimplantation or assisted circulation. One hundred fifty patients (group A) received cerebrospinal fluid drainage (CSFD) and low-dose naloxone (1 microg/kg/hour) as adjuncts to reduce the risk of paralysis. Sixty-seven patients (group B) did not receive CSFD and naloxone. RESULTS: Seventeen deficits occurred in 205 surviving patients: 5 of the 147 in group A (expected deficits = 31) and 12 of the 58 in group B (expected deficits = 13) (p < 0.001). In a multivariate logistic regression model, acute presentation, Crawford type 2 aneurysm, group B membership, and a decrease in cardiac index with aortic occlusion remained significant risk factors for deficit (p < 0.0001). By odds ratio analysis, group A patients had 1/40th the risk of paralysis of group B. The only significant predictor of postoperative renal function was the preoperative creatinine level (p < 0.0001); renal revascularization significantly improved renal function. The mortality rate was 1.6% (2) for patients undergoing elective treatment and 21% (19) for patients who had acute presentations. Acute presentation, age, and the preoperative creatinine level were found to be significant factors for operative mortality in a logistic regression model (p < 0.001) and defined a group at high risk for death. CONCLUSIONS: CSFD and low-dose naloxone significantly reduce the paralysis risk associated with thoracoabdominal aortic replacement. A decrease in the cardiac index with aortic occlusion is a previously unreported variable that defines a subset of patients at higher risk for paralysis.

Adolescent↗
PubMed1986

Cerebral vascular resistance following platelet and leukocyte removal from perfusate.

The rapid increases in cerebral vascular resistance (CVR) frequently observed during extracorporeal perfusion of isolated organs with whole or diluted blood have been investigated using the isolated canine brain preparation. Our data strongly suggest that these increases are caused by a vasoconstrictor that is present in the buffy coat. Plasma serotonin levels were measured and found to be insignificant after conditioning and storage. Conditioning the blood reduced the platelets and the potential for thromboxane A2 production to approximately 40% of normal. However, there was no correlation between thromboxane B2 levels and increases in CVR. Removal of the buffy coat effectively removed all of the leukocytes. Thus, one of the leukotrienes may have been responsible for the buffy coat-induced vasoconstriction.

Animals↗