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Biomedical subjects

V Draxler

Publications and source records attributed to V Draxler.

At least 19 recordsLinked to original sources
PubMed1986

[Differences in the neuromuscular blockade of the larynx and thenar muscles following relaxation with vecuronium].

To objectivate the clinical impression of different neuromuscular depression in the larynx- and limb-musculature, an attempt was made in 5 patients to quantify laryngeal muscle relaxation by electromyographic recordings of evoked responses from the vocalis muscle during endolaryngeal microsurgery. Mechanographic and evoked electromyographic recordings of the thenar muscles were obtained simultaneously. Nearly total suppression of evoked responses at the peripheral muscle site was observed after a bolus dose of either 60 micrograms/kg or 100 micrograms/kg of the nondepolarising muscle relaxant Vecuronium. However, the vocalis muscle was not blocked completely. The neuromuscular depression ranged from 61 to 92% depending on the dose. In no case was the recommended intubating dose (ED 95) of 60 micrograms/kg sufficient for complete relaxation of the vocalis muscle. The present results do not support that the extent and/or time course of intrinsic laryngeal muscle relaxation correlates with peripheral neuromuscular depression in a quantitative manner. The different degree of relaxation achieved by Vecuronium in the hand and larynx is probably due to their different content of acetylcholine receptors.

Adult↗
PubMed1986

[The pharmacodynamics of vecuronium on the musculature of the vocal cords and the ball of the thumb. Preliminary report].

During endolaryngeal microsurgery, an attempt was made to quantify laryngeal muscle relaxation by electromyographic recording of evoked responses from the vocal cord musculature in 5 patients. Both mechanographic and electromyographic recordings from the adductor pollicis were obtained simultaneously. Following a bolus dose of vecuronium (60 micrograms/kg, n = 3, and 100 micrograms/kg, n = 2), nearly total (97%-100%) suppression of evoked responses at the peripheral muscle site was observed; the vocal cords, however, did not show complete neuromuscular (nm) blockade, but rather varying degrees of nm depression ranging from 61%-92%. The present results clearly show that quantitative information as to duration and degree of neuromuscular depression in the vocal musculature may be obtained by electromyographic recordings of evoked potentials in the clinical setting; it is impossible however, to quantitatively estimate the extent of intrinsic laryngeal muscle relaxation from peripheral nm depression. The pharmacodynamic differences observed might be due to the varying acetylcholine receptor density of the muscle groups studied.

Adult↗
PubMed1985

[Non-invasive pulse oximetry for the measurement of oxygen saturation in intensive care patients].

Non-invasive measurements of oxygen saturation are attractive because they provide continuous information which may result in improved patient care. We evaluated a new finger pulse oximeter as a measure of arterial oxygen saturation in critically ill patients with respiratory distress. In 12 patients studied, 133 simultaneous comparisons between in vivo (Pulse-Oximeter, Nellcor, Hayward, California) and in vitro (IL CO-Oximeter 282) oxygen-haemoglobin saturation were made. Linear regression analysis of these pooled data yielded on excellent correlation (r = 0.97, p less than 0.001, 0.3% accuracy). The results demonstrate that non-invasive oxygen monitoring of patients with respiratory failure is feasible and can reliably detect potential life-threating arterial oxygen desaturation.

Carbon Dioxide↗
PubMed1985

[Evaluation of the thermal technic for the quantitative measurement of extravascular lung water].

To evaluate the accuracy of the method, sequential measurements (n = 159) of extravascular lung water (EVLW) using the thermo-dye double-indicator dilution technique were performed in 22 critically surgical ill patients. Radiographic grading of lung water content served as clinical standard. Normal mean EVLW defined radiographically without evidence of pulmonary edema was 4.8 +/- 1.1 ml/kg. Early interstitial fluid accumulation was quite accurately detected with 6.9 +/- 2.1 ml/kg EVLW (p less than 0.001 vs normal lung water content). The mean EVLW present with definitive interstitial and alveolar edema was 11.5 +/- 3.8 ml/kg and 19.1 +/- 4.5 ml/kg, respectively. Despite some objections to the method (diffusion limitation of the thermal indicator, uneven regional lung perfusion), this technique for measuring EVLW reliably assesses the degree of pulmonary edema. Even when properly performed, chest roentgenograms only confirm gross changes in the lung water content.

Adolescent↗
PubMed1985

[Monitoring fiberoptic intubation using non-invasive pulse oximetry].

Non-invasive measurements of oxygen saturation are attractive because continuous information is provided, which may result in improved patient care. We evaluated a new finger pulsoximeter as a measure of arterial oxygen saturation during fiberoptic intubation. Secondly, we studied the kinetics of oxygen-haemoglobin desaturation during the procedure. In 15 patients investigated, 118 simultaneous comparisons between in vivo (Pulsoximeter Nellcor N 101) and in vitro (CO-Oximeter Corning 2500) oxygen-haemoglobin saturation were made. Statistical analysis of these pooled data yielded an excellent correlation (r = 0.94, P less than 0.001). Our results demonstrate that non-invasive oxygen monitoring during fiberoptic intubation is reliable, and we detected oxygen desaturation of less than 80% if ventilation was not assisted.

Adult↗
PubMed1984

[Indications for tracheotomy in long-term ventilated critically ill patients].

In order to evaluate the frequency and indication of tracheotomy in long-term ventilated critically ill patients we analysed retrospectively patients requiring artificial ventilation for periods of more than 7 days. During 1974-75 30 out of 55 of these patients were tracheotomised. In accordance with common practice, early tracheotomy (14 patients) was performed when ventilatory support was expected to exceed 8 to 10 days. In another 16 cases, the same limits were applicable for terminating prolonged tracheal intubation in favour of tracheotomy. In contrast, during the period 1980-81 tracheotomy had been indicated in 8 out of 94 patients. Early tracheotomy was limited to four patients with severe facial injuries accompanied by acute lung failure. The decision to perform tracheotomy or to continue prolonged tracheal intubation was based on definite findings during direct laryngoscopy and fibre bronchoscopy examination of the airways. No late laryngeal sequelae after prolonged tracheal intubation were observed. The risks have been reduced by the use of recently introduced tube materials. Prolonged tracheal intubation has become a safe alternative to tracheotomy.

Critical Care↗
PubMed1983

Hemodynamic and hormonal response to induced hypotension with isosorbide dinitrate and nitroglycerin during anesthesia.

Changes in hemodynamics, plasma catecholamines, and PRA in response to controlled hypotension induced with ISDN (n = 10, mean dose 15.5 micrograms kg-1 min-1) and NTG (n = 7, mean dose 5.5 micrograms kg-1 min-1) were studied during neuroleptanesthesia in patients undergoing facial and neck surgery. Before the commencement of vasodilator infusion the patients were pretreated with metoprolol 0.1 mg kg-1. In addition, enflurane was used to obtain the desired hypotensive level. During ISDN induced hypotension, MAP was reduced from 83 to 63 mm Hg (p less than 0.001). Continuous infusion of NTG resulted in a decrease of MAP from 81 to 53 mm Hg (p less than 0.01). In both groups, HR decreased by 10% (p less than 0.05). For both vasodilators the reduction of MAP was associated with a marked decrease in SVRI (p less than 0.01), while Cl remained largely unchanged. The hemodynamic responses to the two vasodilators were similar, except that NTG reduced PAMP (p less than 0.01) and increased intrapulmonary shunt volume (p less than 0.01). The anesthetic technique attenuated catecholamine and renin release, suppressed reflex tachycardia, and prevented rebound hypertension.

Adolescent↗
PubMed1982

[Rare malposition of a subclavian vein catheter].

Deviation of a left subclavian vein catheter into the azygos vein occurred in a patient with cancer of the colon. On the p.a.-projection, the catheter seemed to be kinked in the vena cava. In the lateral view, the malposition in the azygos vein could be detected and was visualised by giving a bolus of contrast medium. By retracting the catheter under fluoroscopic control the proper position could be achieved. The importance of the lateral-view chest x-ray is discussed.

Aged↗
PubMed1982

[Bedside evaluation of hemodynamic and respiratory data with a programmable pocket calculator].

Information obtained from repeated measurements of basic haemodynamic and pulmonary artery catheterization data has become useful for treatment of critically ill patients. In addition, the determination of cardiac output, the systemic, central venous, pulmonary arterial and pulmonary capillary wedge pressures, and blood gas data of arterial and mixed venous sampling allow to calculate derived cardiorespiratory variables. Since manual computation is a time-consuming measure in the daily routine of an intensive care unit and online computer monitoring an expensive one, we developed a program for bedside use in a handheld programmable calculator. This program incorporates the following characteristics: calculation of standard hemodynamic, oxygen transport and perfusion-related variables, temperature correction of blood gas data, and derivation of oxygen saturation and intrapulmonary shunt.

Blood Gas Analysis↗
PubMed1981

[Jet ventilation in laryngoscopy and microlaryngeal surgery under general anaesthesia (author's transl)].

This is a report on a technique which provides an unimpeded access to the operating field during laryngoscopy and laser microsurgery of the larynx. Under barbiturate-induced neuroleptanaesthesia and relaxation with alcuronium 18 patients were jet-ventilated with nitrous oxide and oxygen. The gas mixture was delivered via an automatic injection ventilator (Injection-Timer, Storz) connected to a short endotracheal tube (Injectoflex, Rüsch - a modified Carden tube). Arterial blood sampling was carried out during the whole procedure. In all patients the recommended technique provided adequate alveolar ventilation with minimal metabolic disturbances; the partial pressures of oxygen exceeded the standard values in all cases. Moderate circulatory alterations were observed. Clinical experience with the anaesthetic technique is presented and the advantages of the modified tube compared with the original Carden tube and former devices for jet ventilation during laryngoscopy are described.

Adolescent↗
PubMed1981

[Chlorprothixene-induced central anticholinergic syndrome (author' transl)].

A case is reported in which unconsciousness and apnoea extending into the postoperative period were noted as a central anticholinergic syndrome caused by chlorprothixene. This compound was employed for preanaesthetic medication in usual clinical dosage. Physostigmine salicylate was effective in reversing the toxic side effects of chlorprothixene - an occasionally active central anticholinergic agent.

Apnea↗
PubMed1980

Experience with "isovolaemic" haemodilution in extensive surgery for oro-facial tumours.

Pre-operative "isovolaemic" haemodilution using 6% hydroxyethyl-starch was used in 7 patients with tumours involving the mouth. While the value of isovolaemic haemodilution in terms of reducing transfusion requirements with donor blood was confirmed, this positive effect was found to be offset by the narrow margin within which blood pressure can be reduced intra-operatively and by the resultant higher blood loss. Wound healing was optimal by clinical evidence. Defective wound healing or necroses due to local hypoxaemia appear to be less likely after isovolaemic haemodilution.

Adult↗
PubMed1980

[Metabolic studies on intensive care patients during gastric tube feeding with a formulated diet, rich in bulk].

Results of metabolic investigations in 5 intensive care patients fed via gastric tube with a prefabricated formula diet (based on milk protein, rich in bulk material) are reported. Clinical handling proved to be rather simple, due to the homogeneity of the mixture tube, obstruction never occurred. Tolerance of the tested tube feeding was good in 4 of 5 patients (in 1 tetanus patient the study to be interrupted because of acute abdominal symptoms), mean body weight increased. During the 10-day treatment period, a slightly positive nitrogen balance (mean 1.4 +/- 5.9 g/day) resulted in a cumulative nitrogen retention of 15.5 g. Fat losses in faeces, probably due to high intake (more than 50% of calories administered), were moderately elevated compared to normal values; in some patients decreased fat resorption with steatorrhoea was observed on various days. The formula diet under investigation may be qualified as a suitable nutritional regime for intensive care patients with intact gastrointestinal function. In cases with impaired fat utilization, however, relative calorie deficiency interfering with protein synthesis (gluconeogenesis) might occur. Lowering of the fat quota (having been taken into account in the meantime) to the benefit of elevated carbohydrates may be desirable in this context.

Adolescent↗