[The effect of propanidid in patients with an increased tendency to cerebral convulsions (author's transl)]. / Zur Wirkung von Propanidid bei Patienten mit erhöhter zerebraler Krampfbereitschaft

In view of the observation of tonic-clonic convulsions after the use of Propanidid in certan patients, a study was undertaken of the effects of this drug (7 mg/kg) on the EEG of 2 volunteers with a known history of epilepsy. Both subjects developed tonic-clonic convulsions and showed typical alterations of the EEG pattern even before the onset of hyperventilation. These EEG alterations were producible also during complete relaxation. The convulsions were easily stopped by the administration of short-acting barbiturates. Similar observations reported in the literature are briefly discussed. The conclusion is drawn that Propanidid should not be given to patients with a known history of epilepsy or any other convulsive disease.

[Chlorprothixene-induced central anticholinergic syndrome (author' transl)]. / Chlorprothixen-induziertes zentral anticholinerges Syndrom.

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.

[Medial AV-nodular rhythm observed during an endolaryngeal micro-surgical intervention (author's transl)]. / Mittlerer AV-Knotenrhythmus bei endolaryngealem mikrochirurgischem Eingriff.

A case of therapy resistant junctional nodal rhythm in the course of a microsurgical laryngeal operation is reported. The interaction of possible reflex mechanisms is discussed. Attempts to reverse the electrocardioscopic findings with drugs were unsuccessful. Diminuation of the mechanical irritation caused by the operation-laryngoscope resulted in immediate return to sinusrhythm.

[Fogarty catheter for the removal of esophageal foreign bodies]. / Fogarty-Katheter zur Entfernung von Osophagusfremdkörpern.

The use of the Fogarty Catheter for the removal of a steel ball oesophageal foreign body in a child is presented. Moreover, the simple operation technique and the advantages compared to foreign body forceps are described.

[Rare malposition of a subclavian vein catheter]. / Seltene Fehllage eines Vena-Subklavia-Katheters.

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.

[Influence of isosorbide dinitrate on haemodynamics and gas exchange in acute respiratory distress syndrome (author's transl)]. / Der Einfluss von Isosorbiddinitrat auf Hämodynamik und Gasaustausch bei der akuten respiratorischen Insuffizienz.

The effects of intravenous isosorbide dinitrate (ISDN: 3, 6, 9, and 12 mg/h) on systemic and pulmonary vasculature, gas exchange, and dynamic lung compliance were investigated in 7 controlled ventilated patients suffering from ARDS after trauma or in sepsis. Parameters were recorded before and after 20 min. ISDN infusion with 30 min interruption between the different dosage steps. Systemic circulation, heart rate, cardiac index, and stroke index remained grossly unchanged. MPAP was significantly decreased at 6, 9, and 12 mg/h ISDN to 61,7%, 61%, and 69,3% of initial value, as well as PCWP to 49,6% 45,5% and 41,5% of initial value. The drop of RVSWI at 6 and 9 mg/h ISDN to 59,1% and 63,2% also was statistically significant. There was an increase in Qs/Qt, AaDO2, and dynClung, though the increases were not statistically significant. O2availability remained unchanged. Administration of ISDN in ARDS causes an improvement in right ventricular function due to a reduction of pre- and afterload as well as intrapulmonary blood volume. In a similar manner increasing lung compliance may be explained by volume shif. The slight alterations of ventilation-perfusion-ratio as seen by increases in Qs/Qt and AaDO2 can be tolerated because of the unchanged O2availability.

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.

[Monitoring fiberoptic intubation using non-invasive pulse oximetry]. / Uberwachung der fiberoptischen Intubation mittels nicht invasiver Pulsoximetrie.

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.

[Non-invasive pulse oximetry for the measurement of oxygen saturation in intensive care patients]. / Nicht-invasive Pulsoximetrie zur Bestimmung der Sauerstoffsättigung bei Intensivpatienten.

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.

[Jet ventilation in laryngoscopy and microlaryngeal surgery under general anaesthesia (author's transl)]. / Injektbeatmung bei direkter Laryngoskopie und endolaryngealen mikrochirurgischen Eingriffen in Allgemeinanaesthesie.

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.

[Bedside evaluation of hemodynamic and respiratory data with a programmable pocket calculator]. / Bettseitige Auswertung von hämodynamischen und respiratorischen Daten mittels eines programmierbaren Taschenrechners.

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.

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.

The role of the anaesthesiologist in the intra- and post-operative management of kidney transplant patients.

Based on experiences with 256 kidney transplant operations in 239 patients over a period of ten years (18.6. 1965 to 15.4. 1975) the role of the anaesthesiologist as it had developed in our institution has been described. Some problems with regard to the anaesthetic management of living donors were discussed. The care of patients who, due to their deteriorating cerebral function, are potential donors was also described. An outline of the own anaesthetic management of the recipient has been given and alternative methods were mentioned. Some special points were specifically stressed like the choice of relaxants, fluid replacement, blood transfusion, diuretic treatment starting already intraoperatively. Good intensive care of the potential donor is of great importance for the function of the transplanted organ. Very important is also the postoperative treatment of the recipient, which in our institution is performed in a teamwork between anaesthesiologist, surgeon and nephrologist. Finally, the functional results of our series are briefly demonstrated.

[Effect of a 3.6 o/o dextran Ringer acetate solution on moderately hypovolemic patients in intensive care]. / Einfluss einer 3,6% igen Dextran-Ringer-Azetatlösung auf mässig hypovolämische Intensivpatienten.

The effects of 1000 ml 3.6% dextran Ringer's acetate solution (Mw 61,800; infusion time 60 min) on circulation, blood and plasma volume, blood viscosity and renal function parameters were investigated, the renal elimination of dextran also being measured. During the entire investigation period no significant alterations of cardiocirculatory parameters, blood and plasma volume and rheological properties of blood could be demonstrated, the same holding true for kidney function values. Dextran excretion was about 33% three hours after the end of infusion, reaching 51% of the whole amount given 21 hours later. It has to be assumed that mainly macromolecular dextran components of less efficiency are retained intravascularly. Taking into consideration the practically absent volume expanding effect - even at the end of infusion period - this dextran solution cannot be recommended as a blood substitute during acute hemorrhage or as an "expander" in other shock states.

[Metabolic studies on intensive care patients during gastric tube feeding with a formulated diet, rich in bulk]. / Stoffwechseluntersuchungen an Intensivpatienten während Sondenernährung mit einer ballaststoffhaltigen Formuladiät.

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.

[Differences in the neuromuscular blockade of the larynx and thenar muscles following relaxation with vecuronium]. / Unterschiede in der neuromuskulären Blockade der Kehlkopf- und Thenarmuskulatur nach Relaxation mit 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.

[The pharmacodynamics of vecuronium on the musculature of the vocal cords and the ball of the thumb. Preliminary report]. / Zur Pharmakodynamik von Vecuronium an Stimmband- und Thenarmuskulatur. Vorläufige Mitteilung.

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.