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Biomedical subjects

W Mühlemann

Publications and source records attributed to W Mühlemann.

8 recordsLinked to original sources
PubMed1991

Major coagulation disorders when using aprotinin--observations on a case.

Intraoperative application of the proteinase inhibitor aprotinin allows to drastically reduce blood loss during and after cardiopulmonary bypass operation. The side effects of this therapy (if any) have not been systematically registered and a possible interaction with heparin is not excluded. Such an interaction seems to have occurred in one of our patients. He developed a resistance to heparin shortly after prophylactic administration of aprotinin and maintained it for about one hour after discontinuation of the aprotinin. Prophylactic and therapeutic implications of this observation are briefly exposed.

Aged↗
PubMed1990

[Quantitative and qualitative analysis of various blood-preserving measures in heart surgery].

We assessed quantitative aspects of blood salvage retrospectively in 270 consecutive coronary bypass patients over one year. They were assigned either to group A (n = 10, Cellsaver [Haemonetics]), B (n = 189, centrifugated oxygenator blood), C (n = 107, retransfusion of shed mediastinal blood) or D (n = 74, combination of method B and C). In addition, blood quality was studied prospectively in group A (n = 5), B (n = 10) and C (n = 10) and each group compared to a control group. Results (mean values/patient) were: Blood salvage with A yielded 570 +/- 230 ml (hematocrit = 50%), B 509 +/- 156 ml (69%) and C 593 +/- 430 ml (26%). The required homologous blood products, i.e. packed cells (PC) and fresh frozen plasma (FFP) diminished significantly when combined autologous blood salvage was used (PC 6.0 +/- 3.4 vs 3.4 +/- 1.9, p less than 0.05; FFP 3.4 +/- 3.8 vs 2.6 +/- 3.0). Autologous erythrocyte function assessed by 2,3DPG was normal in all three methods (range 14.77-16.03 mumol/gHb). ATP was nearly normal in A (3.34 +/- 0.45 mumol/gHb), reduced by 20% in B (3.21 +/- 1.14 mumol/gHb) and by 30% in C (2.56 +/- 0.78 mumol/gHb) compared to the corresponding preoperative patient value. Hemolysis (free plasma hemoglobin) (was elevated in A (63 +/- 7 mg/dl), B (202 +/- 57 mg/dl) and C (211 +/- 44 mg/dl). However, no increase of free plasma hemoglobin was encountered in our patients after retransfusion of either A, B or C. No side effects were detected and bacteriology remained negative in all examined blood samples in C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1990

Accidental deep hypothermia with cardiopulmonary arrest: extracorporeal blood rewarming in 11 patients.

Sixteen patients (age 13-53 years) with accidental deep hypothermia have been rewarmed in our clinic during the last 10 years, 14 by femoro-femoral cardiopulmonary bypass (CPB) of whom 11 had a cardiopulmonary arrest (asystole in 5 and ventricular fibrillation in 6). On admission, the latter were clinically dead showing wide non-reactive pupils and being supported by ventilation and external heart massage. In the survivors, the mean length of cold exposure was 4.4 h (2-5.5 h) and mean arrest interval until initiation of CPB was 2.5 h (1.4-3.7 h). Rectal temperature on admission ranged from 17.5 degrees C to 26 degrees C (mean 22.5 degrees C). The causes for hypothermia were fall into a crevasse (5), avalanche (1), drowning (2) and cold exposure (3) including 2 suicide attempts. Results are summarized in the following table: [table: see text] Eight of the 11 patients with deep hypothermia and cardiac arrest were rewarmed and resuscitated successfully with CPB. Three patients, including 2 cases of asphyxia (avalanche and drowning), could not be weaned from CPB despite adequate rewarming. The other drowned patient (53 years) died on the 3rd postoperative day (POD) from ARDS. The main complication was pulmonary edema (57%) and transient neurological deficits. All survivors became conscious during the first POD and resumed, their professional activity. We conclude that patients with accidental deep hypothermia and even prolonged cardiopulmonary arrest should be rewarmed and resuscitated rapidly by cardiopulmonary bypass. These measures are very promising particularly if the cause of accident and the circumstances suggest that cardiopulmonary arrest was induced by hypothermia alone without other asphyxiating mechanisms.

Adolescent↗
PubMed1990

[Risk factors for neurologic complications in aortocoronary bypass surgery].

In a prospective study risk factors for neurological complications were evaluated in 300 unselected patients undergoing open heart surgery due to coronary artery disease. Patients with combined procedure (aorto-coronary bypass graft and valve replacement) were excluded from the study. Six patients (2%) suffered from a neurological event in the early postoperative period. A strong risk factor is the age (65 +/- 6 years in the symptomatic group, 56 +/- 9 years in the asymptomatic group, p = 0.009, Student-t-test, double-sided). A certain tendency is seen in patients with carotid stenosis (17% in the symptomatic group, 5% in the asymptomatic group), in patients with a positive neurological history (17% in the symptomatic group, 1% in the asymptomatic group) and in patients with operative revision (33% in the symptomatic group, 4% in the asymptomatic group). No difference was seen in the risk factors sex, lesions of the middle cerebral artery and the ECC-time.

Aged↗
PubMed1982

Management of profound accidental hypothermia with cardiorespiratory arrest.

Complete recovery following rapid rewarming is described in three tourists who were admitted in a state of profound hypothermia with total cardiorespiratory arrest (rectal temperature ranging from 19 to 24 C). In all three patients, respiration and circulation had ceased during the rescue operation. Rapid core rewarming was achieved by thoracotomy and continuous irrigation of the pericardial cavity with warm fluids in one patient, whereas in the other two patients rewarming was accomplished with extracorporeal circulation using femoro-femoral bypass. In the first patient, the heart could not be defibrillated earlier than 90 minutes following thoracotomy; in the other patients rewarming was attained very rapidly, and within half an hour after institution of bypass, resuscitation of the heart was successful. The patients fully recovered their intellectual and physical abilities, despite the prolonged periods of circulatory arrest lasting from 2 1/2 to 4 hours. We conclude that rapid core rewarming is the adequate therapy for profound accidental hypothermia with circulatory arrest or low cardiac output. If feasible extracorporeal circulation represents the method of choice because it combines the advantage of immediate central rewarming with the benefit of efficient circulatory support, the heart is rewarmed before the shell, thus preventing the "rewarming shock" due to peripheral vasodilatation. Resuscitative efforts should be promptly initiated and vigorously pursued, even in the state of clinical death; in profound hypothermia neurologic examination is inconclusive regarding prognosis.

Accidents↗