Biomedical subjects
Publications and source records attributed to T Fösel.
The Endotest is a simple device for monitoring the cuff pressure of an endotracheal tube. No complications could be observed during a 6 month period of usage in the daily routine. We found the handling very good and cuff pressure monitoring very useful.
The following methods for monitoring the ventilation in general anaesthesia can theoretically be applied for neonates and small infants: The use of a precordial stethoscope, measurements and observation of the ventilation pressure, analysis of the inspiratory oxygen concentration, measurement of the expiratory volume, analysis of end-tidal CO2, transcutaneous O2 and CO2 measurement and blood gas analysis. These methods are evaluated and their limitations discussed. Special attention is paid to the application of these methods used in the different paediatric anaesthetic systems. A three graded plan which classifies the risks for the patients and/or the operations is presented in order to rationalize the use of these methods, some of which require expensive equipment. The basic ventilation monitoring includes, even for short operations in healthy patients (Grade I), the precordial stethoscope, the measurement of the inspiratory oxygen concentration, the measurement of the ventilation pressure and, for school age children also measurement of the expiratory volume. For operations lasting longer than one hour (Grade II) end-tidal CO2 analysis should be used when the ventilation-perfusion ratio is undisturbed. Transcutaneous O2 is desirable, but at the present time not accurate for conditions of general anaesthesia. For all high risk patients and/or operations (Grade III), particularly in the neonates, arterial blood gases are indispensable as well as the other methods for monitoring ventilation.
In a randomized study on 150 patients (ASA 1) undergoing induction of anaesthesia, the effects of Fentanyl (0.1 mg), the combination of Fentanyl (0.1 mg) and Droperidol (5 mg) (Innovar, Thalamonal) and Atropine (0.01 mg/kg b.w.) alone on cardiocirculatory parameters were studied. Induction and intubation were carried out with Thiopentone and Succinylcholine. All patients were aged between 18 and 50 years. In addition to continuous ECG recording of standard leads I-III, blood pressure measurements (Riva-Rocci), capillary blood gases and serum potassium were estimated at regular intervals. Prior to intubation Atropine caused arrhythmias in 10% and during intubation in 40%, half of which occurred repeatedly. In comparison, the control group showed arrhythmias in only 28% at intubation time. The median value of the rate pressure products rose before intubation time to levels of almost 20,000 units whereas the control group reached the same high product only during intubation. Cardiac rhythm proved most stable using Fentanyl, the systolic, diastolic and mean blood pressure changes were significantly lower than in those groups without an additional analgesic. With Fentanyl and Atropine the increase of all haemodynamic parameters was less pronounced than in the control group given Atropine only. Comparison of the Fentanyl groups showed only a significantly lower arterial mean pressure when Atropine was given, the other parameters were similar. Using Innovar alone, 4 cases of severe and 1 of mild rhythm disturbances appeared, while with Innovar plus Atropine only 2 cases of mild and 1 of repeated extrasystoles occurred. In the Atropine-free groups, the addition of Innovar only caused a lesser increase in the heart rate, while the remaining parameters did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)
While the occurrence of morphological and functional small intestinal alterations in chronic uraemia is well established, analyses of intestinal lipid utilization are rare. In the present study faecal fat excretion in chronically uraemic humans and rats and the reesterification of a long-chain fatty acid in the mucosa of the small intestine of uraemic rats were investigated. -Reesterification of 14C-palmitic acid in the intestinal mucosa of rats with chronic uraemia produced by 5/6-nephrectomy (BUN 37.8 +/- 12.8 mg/100 ml, serum creatinine 3.0 +/- 0.44 mg/100 ml) was found to be significantly lower (374.2 +/- 166.8 mumol/mg protein x h) than in controls (604.9 +/- 274.2 mumol/mg protein x h) pointing to a disturbance of the intracellular process of absorption of long-chain fatty acids. However, the mean daily fat excretion in the faeces of chronically uraemic rats fed a diet with normal (4.2 per cent) or relatively high fat content (10 and 15 per cent) was not increased. In 20 patients with chronic renal insufficiency (BUN 75.9 +/- 35.9 mg/100 ml, serum creatinine 7.5 +/- 2.8 mg/100 ml) the faecal fat excretion was within the normal range (4.2 +/- 1.2 g/day). These results indicate a sufficient compensation of the impaired intestinal reesterification of fatty acids by the large functional reserve of the small intestine.
In a total of 110 patients with chronic renal failure, 46.4% of the cases had a serum lipase activity exceeding 200 IU, the upper limit of the norm. The degree of reduction of renal function is positively correlated to the frequency of hyperlipasaemia as well as to the elevation of the lipase activity in serum. At a glomerular filtration rate (GFR) of less than 20 ml/min, hyperlipasaemia in chronic glomerulonephritis was found in 75%, significantly more frequent than in chronic pyelonephritis (46.8%). The frequency and degree of hyperlipasaemia was not influenced by haemodialysis. Significantly elevated serum lipase activities were also observed in experimentally produced chronic renal failure in the rat.