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W Mauritz

Publications and source records attributed to W Mauritz.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Preoperative plasma exchange in treatment of plasma-related coagulation disorders before liver transplantation].

PATIENTS AND METHODS: Seventy-two consecutive patients undergoing orthotopic liver transplantation at the Department of Surgery I, University of Vienna Medical School (OLT nos. 1 to 72), were evaluated. Their mean age was 47 years (range: 18-63 years). The indications for liver transplantation are listed in Table 1. All transplant procedures were performed without using a bypass technique. The intraoperative management and surgical procedure have been described elsewhere [7]. Patients were categorized in two groups, each of which was divided in two subgroups. Group I consisted of 18 patients transplanted before the introduction of preoperative plasma exchange. These were retrospectively allocated to two subgroups on basis of their preoperative prothrombin times (PT): A (n = 9): preoperative PT less than 40%; B (n = 9): preoperative PT greater than 40%. The two subgroups of group 2, which contained 54 patients, were compared on a prospective basis: C (n = 32): preoperative PT above 40%; D (n = 22): PT on admission below 40%, preoperative plasma exchange. Comparison of the two subgroups was based on the following parameters: (1) pre-exchange PT (subgroup D); (2) preoperative PT (= PT post-plasma exchange in subgroup D; (3) intraoperative infusion volumes (balanced electrolyte solutions and human albumin to maintain an intravascular colloid osmotic pressure greater than 16 mm Hg); (4) transfusion volumes (whole blood stored for no more than 72 h or packed red cells and fresh plasma, as available; and (5) intraoperative sodium bicarbonate requirements to maintain an arterial pH greater than 7.20. RESULTS: (Table 2) . Prothrombin time (PT): Group 1: Patients in subgroup A had a mean preoperative PT of 34% (range: 15%-40%). This was significantly lower than in subgroup B (74%; 52%-100%; P less than 0.001). Group 2: The pre-exchange mean PT in subgroup D was 27% (12%-39%) vs. 68% in subgroup C (45%-104%), the difference being highly significant (P less than 0.0001). In patients in subgroup D a mean plasma volume of 3638 ml was exchanged by plasmapheresis. This resulted in a significant increase in PT to 55% (Table 3). As a result, the preoperative post-exchange PT in subgroup D was slightly but significantly (P less than 0.005) less than in subgroup C. Transfusion volumes: Group 1: Patients in subgroup A needed significantly more blood units than those in subgroup B (55.3 units [19-110] vs. 18.7 [3-33]).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[The action of ketamine on muscle contractile behavior. In vitro studies on the musculature of subjects susceptible to malignant hyperthermia].

Since ketamine has been incriminated as triggering malignant hyperthermia (MH) [3, 9, 13, 14, 18], but has still been used uneventfully in MH susceptible patients, we performed an in vitro study to examine the safety of ketamine for use in human MH. METHODS. Muscle specimens of 20 patients who had muscle biopsies to diagnose MH were investigated. In every patient diagnostic contracture tests (2 halothane (Hal) and 2 caffeine (Caf) were done according to the protocol established by the European MH group (EMHG). In addition, one test unit for investigating the effect of stepwise increased bath-concentrations of ketamine (5, 10, 20, 60, 120, 240 and 960 mumol/l) and a further one serving as control (no drugs added to the bath) were used. Combined Hal (2 vol%) and Ket (960 mumol/l) tests were performed in 9 patients (4 MHS, 4 MHN, 1 MHEh). Changes in baseline contractures and mechanical twitch tension were evaluated. RESULTS. The diagnostic test showed MHS in 8, MHN in 8 and MHEh in 4 patients. Ketamine did not induce baseline contractures in any of the tests performed. Contractures induced by 2 vol% of halothane in 4 MHS muscles did not change significantly when ketamine was added to the bath (concentration 960 mumol/l). A significant, dose-related decrease in mechanical twitch tension occurred, when ketamine was added to the test. At the highest concentration (960 mumol) twitch tension was reduced by 55%. Twitch tension remained stable in untreated muscles. No significant differences were found between the specimens from MHS, MHN and MHE patients. This reduction in twitch tension was more pronounced in specimens exposed to both halothane (2 vol%) and ketamine (960 mumol/l), resulting in an average decrease of 71%. CONCLUSION. In accordance with Fletcher et al., our results indicate that ketamine - at least in vitro - does not trigger MH. In MHS muscles, ketamine does not augment halothane-induced baseline contractures. The ketamine-induced reduction of mechanical twitch tension in directly stimulated human muscles has not been described before. Analogous findings in frog sartorius muscles can be found in the literature. Whereas the effect of ketamine on indirectly stimulated muscle has been investigated by several authors, the underlying mechanism of ketamine-induced twitch suppression in directly stimulated muscles is not known. Inhibition of calcium release from or accelerated uptake into the sarcoplasmatic reticulum have been reported.

Caffeine↗
PubMed1989

[Liver transplantation--anesthesiology aspects].

Based on our experience in 82 liver transplant procedures performed without using a bypass-technique, we report on our current perioperative anaesthetic management. Preoperative plasma exchange with fresh frozen plasma proved very effective in 16 patients with severe coagulation defects, leading to a significant increase in prothrombin time from 27 to 55%. Intra- and postoperative haemodynamic profiles of 48 patients are presented. Baseline measurements revealed a hyperdynamic circulatory state with elevated cardiac index (CI) and heart rate in all patients. During the anhepatic phase CI and mean arterial pressure (MAP) were persistently lowered. Immediately after reperfusion of the graft, reflux of the stagnant venous content induced a significant increase in CI and led to a moderate elevation of pulmonary artery pressure. MAP showed a rather slow recovery, but was within the normal range at the end of surgery. Oxygen consumption index, which was significantly lowered during the anhepatic period, excessively increased after reperfusion of the graft.

Adult↗
PubMed1988

Malignant hyperthermia susceptibility confirmed in both parents of probands. A report of three Austrian families.

From 1976 to 1986, 79 cases of suspected malignant hyperthermia (MH) were reported to the authors' institution. A total of 233 muscle biopsies was done in 66 families. The mother and father of the proband were investigated in 44 families; in three of these, both parents of probands gave positive test results. These three families, all from Vorarlberg, a secluded mountain area, represent 4.5% of all our MH-positive families (n = 61) and 7.3% of all MH-positive families where both parents had been tested (n = 41). This observation might be explained by: 1) a much higher incidence of MH in this part of Austria, and 2) a different test policy, as at the authors' institution, if possible, both parents are investigated, even if there is a positive test result in one of them. It is concluded that family investigations of MH susceptibility should always include both parents of a proband.

Adult↗
PubMed1988

[Protracted action of vecuronium in a patient with chronic renal insufficiency treated by dialysis].

Although the pharmacokinetics of vecuronium are altered by the loss of kidney function, they do not differ significantly between patients with normal renal function and patients with renal failure. Therefore, the drug has become a preferred neuromuscular blocking agent in anuric patients. The author observed complete relaxation--verified by nerve stimulation--for more than 3 h following a single dose of 0.09 mg/kg vecuronium in a patient with chronic renal failure. Liver function was normal, and no drugs known to interact with vecuronium were used. The authors conclude that the altered pharmacokinetics of vecuronium in anuric patients might cause clinically significant effects in some patients.

Adult↗
PubMed1988

[Hemodynamic and metabolic changes during orthotopic liver transplantation].

Hemodynamic and metabolic profiles were obtained on 48 adult patients (mean age 46 years) undergoing orthotopic liver transplantation without using a bypass technique during the anhepatic period. Baseline measurements after induction of anesthesia (A) revealed a high-output circulatory state. During hepatic dissection (B, preclamping control), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and elevated cardiac index (CI) were well maintained. Preoperative plasma exchange with fresh frozen plasma in the presence of severe coagulation defects and liberal use of platelet concentrates limited the need for massive blood transfusion, and thus contributed to stable hemodynamics during this stage. Significant cardiovascular changes occurred immediately after clamping of the inferior vena cava and the portal vein (C): there was a marked fall in MAP (-30%), MPAP (-45%), PCWP (-48%), RAP (-40%), and CI (-60%) reflecting the hemodynamic adaptation to the impeded venous return. At the end of the anhepatic period (D), MAP (-21%), MPAP (-38%), PCWP (-39%), RAP (-24%), and CI (-56%) were persistently lowered because no attempts were made to attenuate the clamping response by vigorous volume expansion or infusion of inotropic drugs. The reduction in oxygen availability index (O2AVI) was compensated by enhanced oxygen extraction. Oxygen consumption index (VO2I) fell secondary to the removal of the liver and the decrease in body temperature (BT). Potassium levels and acid-base balance were well controlled; no hypoglycemic episode was observed during the anhepatic period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1988

[Malignant hyperthermia in Austria. III. Anesthesia in susceptible patients].

Anesthesia in patients susceptible to malignant hyperthermia (MH) is generally considered to be very risky, although - with one notable exception - there are no prospective studies about anesthetic management in a large number of such patients. The prophylactic use of dantrolene has been recommended in MH patients, although there is no strong evidence supporting this - despite the fact that dantrolene may have serious side effects. We therefore decided to report the results of our own anesthetic technique for MH patients, as our technique does not include the prophylactic use of dantrolene. From 1981 to 1988, 19 operations on 16 MH-susceptible patients were performed. Patients 1-4 were pediatric survivors of an MH episode, where MH susceptibility was confirmed by muscle biopsy and in vitro contracture tests in at least one parent; patients 5-7 were survivors of an MH crisis, and they later underwent diagnostic muscle biopsies themselves; all other patients (nos. 8-16) were relatives of MH survivors with positive in vitro contracture tests. Diazepam, pentobarbital, pethidine, and chlorprothixene were used for premedication; no prophylactic dantrolene was given. Anesthesia was induced by thiopentone and was continued by nitrous oxide/oxygen, fentanyl, and droperidol; alcuronium, atracurium, and vecuronium were administered as necessary. Pyridostigmine, atropine, and naloxone were used if appropriate. New or disposable tubings were used for ventilation, and the vaporizers were removed from the anesthesia machines. ECG and body temperature were recorded in all patients; blood pressure was monitored invasively if indicated; end tidal CO2 was monitored whenever possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Malignant hyperthermia in Austria. II. A comparison of the results of diagnostic test procedures].

During the last 4 years different diagnostic procedures for the detection of malignant hyperthermia (MH) susceptibility have been used at the authors' clinical unit; this study was designed to compare the results of these tests. PATIENTS AND METHODS. Since March 1983, 158 patients have been referred for the following reasons: group A: probands (n = 17) who had had symptoms of MH during anesthesia; group B: patients of probands (n = 48) if the latter were not tested because of age (n = 24) or death (n = 2); group C: relatives from MH families (n = 86); group D: patients (n = 5) who developed fever during stress and/or physical activity (n = 3), had myotonia (n = 1), or developed rhabdomyolysis during intensive care (n = 1); group E: controls (n = 2). Two static halothane and two static caffeine tests according to the European protocol were performed in all patients (n = 158). Histological examinations of skeletal muscle (fixed in glutaraldehyde, stained with hematoxylin-eosin, Gieson, and toluidine blue) were done in the first 100 patients; all specimens were scored by the same investigator (E.S.). Score 0: normal; 1: increased number of sarcolemma cores; 2: 1+cores forming groups; 3: 1+2+fiber degeneration; 4: specific changes-myopathies. Plasma levels of creatine kinase (CK) were determined in the first 50 patients. Complete neurological examinations, including electromyography (EMG), were done in ten patients who had increased CK levels as well as histological scores of 3 or 4 (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Comparative review of various resuscitation procedures].

During the last 10 years many experiments have confirmed the theory that blood flow during CPR likely occurs as a result of manipulation of intrathoracic pressure. In order to improve vital organ perfusion by increasing intrathoracic pressure many different techniques of CPR have been developed. These include "new CPR" (simultaneous ventilation and compression), asynchronous ventilation, prolonged compression, and continuous or interposed abdominal compression. Other methods like open chest CPR and the use of mechanized CPR or even cardiopulmonary bypass have also recently been proposed. All these techniques are reviewed in detail.

Heart Arrest↗
PubMed1987

[Results of cardiopulmonary and cerebral resuscitation in the area of surgical intensive care].

In intensive care units specially trained staff and sophisticated technical equipment are confronted with extremely critically ill patients. In this patient population multiple organ failure is mostly established thus requiring application of all therapeutic facilities. During a study period of 40 months in 203 (86.4%) out of 235 patients with cardiac arrest a decision not to resuscitate ("DNR order") was made. In 32 patients cardiopulmonary resuscitation was attempted. Although spontaneous circulation could be maintained for at least 12 hours in 40.6% (13 patients), 6 died within the first day and 3 other patients died during the first week. Only 4 patients resuscitated could be discharged. Our data suggest that, despite further development of technical and therapeutic methods, the underlying disease has to be considered as the limitation of long-term survival.

Adolescent↗
PubMed1987

[Plasma exchange in acute abdomen with multiple organ failure--a case report].

Following four weeks of conservative treatment of acute pancreatitis a 43 years old female was admitted to our ICU in severe circulatory shock (MAP less than 50 mmHg despite dopamine and dobutamine 5 mcg/kg/min, and norepinephrine 0.4 mcg/kg/min), respiratory failure, incipient renal failure and coma. Laboratory examination revealed thrombopenia (14 G/l) and leucopenia (0.5 G/l), as well as impaired prothrombine time (20%) and partial thromboplastine time (greater than 2 min). As abdominal sepsis was suspected to be the most likely cause of the patients multiple organ failure, a laparotomy was planned. To improve coagulation prior to surgery, plasmapheresis was performed exchanging 4.8 liters of plasma with fresh frozen plasma. In addition 3 units of platelets were transfused. The effects of the plasmapheresis were an improvement of circulatory as well as coagulatory parameters. Laparotomy revealed toxic megacolon, whereas the pancreas seemed to be normal; a coecostomy and a transversostomy were performed. The patient thereafter improved gradually; catecholamine doses were reduced, renal function recovered and five days postoperatively weaning from the ventilator was possible. Platelet substitution (6 more units), fresh frozen plasma administration (76 units à 200 ml) and AT III substitution (total 10,500 U) had to be continued throughout the first week. Five weeks after this operation, which would have been impossible without preoperative plasmapheresis, the patient was discharged in good health.

Abdomen, Acute↗