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  • 1
    Electronic Resource
    Electronic Resource
    Ethanol reduces excitability in a subgroup of primary sensory neurons by activation of BKCa channels (2001)
    Oxford, UK : Blackwell Science Ltd
    European journal of neuroscience 14 (2001), S. 0 
    Details
    ISSN: 1460-9568
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ethanol effects on the central nervous system have been well investigated and described in recent years; modulations, by ethanol, of several ligand-gated and voltage-gated ion channels have been found. In this paper, we describe a shortening of action potential duration (APD) by ethanol in ≈ 40% of small diameter neurons in rat dorsal root ganglia (DRG). In these neurons, designated as group A neurons, we observed an ethanol-induced increase in whole-cell outward-current. As iberiotoxin, a specific blocker of large-conductance calcium-activated K+ channels (BKCa channels), blocks the effects of ethanol, we investigated the interaction between these channels and ethanol in outside-out patches. Open probability of BKCa channels was increased 2–6 × depending on the concentration (40–80 mm≈ 2–4‰ v/v) of ethanol. Functional consequences were a prolongation of the refractory period, which was reversible after addition of iberiotoxin, and reduced firing frequency during ethanol application. In contrast, another type of neuron (group B) showed a prolonged APD during application of ethanol which was irreversible in most cases. In 90% of cases, neurons of group A showed a positive staining for isolectin B4 (I-B4), a marker for nociceptive neurons. We suggest that the activation of BKCa channels induced by clinically relevant concentrations of ethanol, the resulting modulations of APD and refractory period of DRG neurons, might contribute to clinically well-known ethanol-induced analgesia and paresthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.0953-816x.2001.01754.x
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  • 2
    Electronic Resource
    Electronic Resource
    A combined stage 1 and 2 repair for hypoplastic left heart syndrome: anaesthetic considerations (2003)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 13 (2003), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Therapy of hypoplastic left heart syndrome (HLHS) consists of the staged Norwood procedure or cardiac transplantation. Stenting the ductus arteriosus and subsequent banding of the pulmonary arteries allows the combination of neoaortic reconstruction with the establishment of a bidirectional cavopulmonary connection (combined stage 1 and 2 procedure) in a later session. We report the anaesthetic management in eight infants ranging from 107 to 195 days undergoing a combined stage 1 and 2 procedure. Nonselective pulmonary vasodilators and nitric oxide were needed in all cases to improve oxygen saturation in the postbypass period. Phosphodiesterase inhibitors and epinephrine were required in all patients for inotropic support during and after weaning off cardiopulmonary bypass. The procedure was successful in seven patients. One patient died intraoperatively because of right heart failure. The physiological changes of this new surgical strategy for palliation of HLHS offers a challenge for the anaesthetist primarily in the early postbypass period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.01047.x
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  • 3
    Electronic Resource
    Electronic Resource
    Massive doses of methylprednisolone (30 mg/kg) in man: Immediate haemodynamic effects in “low output state” (1977)
    Springer
    Intensive care medicine 3 (1977), S. 69-76 
    Details
    ISSN: 1432-1238
    Keywords: Methylprednisolone ; Cardiac surgery ; Haemodynamics ; Low output state
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Methylprednisolone, 30 mg/kg body-weight, was given as an intravenous bolus injection to a total of 31 cardiosurgical patients. Measurements of left ventricular parameters showed no significant increase in dp/dtmax and no significant decrease in left ventricular end-diastolic pressure. There were no important changes in blood pressure, heart rate, cardiac index, stroke index and total peripheral resistance. During ‘steady state’ extracorporeal circulation no relevant vasodilating effect could be found. In comparison to a control-group there were no important differences in haemodynamic parameters. In cardio-surgical patients, — mainly functional class III — we were unable to demonstrate any gross cardiovascular effects of large doses of methylprednisolone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01683064
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  • 4
    Electronic Resource
    Electronic Resource
    Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia (1995)
    Springer
    Journal of clinical monitoring and computing 11 (1995), S. 92-98 
    Details
    ISSN: 1573-2614
    Keywords: Anesthesia, general ; Anesthetics, intravenous: etomidate, fentanyl, ketamine, methohexital, midazolam, propofol, thiopental ; Ultrasonics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco 2 of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco 2 (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01617730
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  • 5
    Electronic Resource
    Electronic Resource
    Use Of an Anesthesia Information Management System (AIMS) To Evaluate The Physiologic Effects Of Hypnotic Agents Used To Induce Anesthesia (2000)
    Springer
    Journal of clinical monitoring and computing 16 (2000), S. 183-190 
    Details
    ISSN: 1573-2614
    Keywords: Anesthesia Information Management System (AIMS) ; Patient Data Management System (PDMS) ; quality assurance ; induction hypnotics ; data mining
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective.The aim of this study was to utilize an anesthesiainformation management system (AIMS) in investigating the effects of hypnoticagents used to induce anesthesia on blood pressure, heart rate and arterialoxygen saturation. The characteristics of these agents, known from previousstudies, were compared to the effects documented in this study during routineclinical use. Methods.During the years 1997 and 1998, all relevantdata from anesthetic procedures were recorded online using the automatedanesthesia information system NarkoData. The data from 8,078 generalanesthesia procedures using endotracheal intubation were exported via“structured query language” (SQL) from the AIMS database into astatistics program after excluding children (age 〈 14), patients whoreceived atropine during induction and procedures with use of extracorporealcirculation. The effects of drug administration on systolic, diastolic andmean arterial blood pressure (SBP, DBP, MBP), heart rate (HR) and arterialoxygen saturation (SpO2) were analyzed prior to induction and at5, 10 and 15 minutes following bolus administration of the hypnotic agent. Thedata were classified into three groups based on the induction agent used:thiopental, etomidate or propofol and further separated into two groups basedon ASA status (ASA ≤ II and ASA 〉 II). The mean and standard deviationswere calculated for each parameter at each point in time. Statisticalcomparisons were performed to determine whether the results for each timepoint differed from the previous time point. Results.There was asignificant decrease in blood pressure (MAP, SBP, DBP) after bolusadministration of all three hypnotics in all of the 8,078 procedures analyzed.The decrease was greater in patients of ASA class 〉 II than in those of ASAclass ≤ II. Propofol caused the greatest drop in blood pressure whereasetomidate caused the least. During the observation period the HR also fell ineach group, except for thiopental where an initial rise of the HR could beobserved. An initial rise of SpO2 was recorded in each group withno differences observed between the individual hypnotics. Conclusions.The effects of the induction hypnotic agents thiopental, etomidate andpropofol on blood pressure and heart rate as documented by an AIMScorresponded to those found in clinical studies. An AIMS with thecorresponding documentation, software and database structure is suitable forcollecting and evaluating data for clinical investigations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009937510028
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  • 6
    Electronic Resource
    Electronic Resource
    Using an Anesthesia Information Management System to Prove a Deficit in Voluntary Reporting of Adverse Events in a Quality Assurance Program (2000)
    Springer
    Journal of clinical monitoring and computing 16 (2000), S. 211-217 
    Details
    ISSN: 1573-2614
    Keywords: Quality assurance ; medical record system, computerized ; perioperative complications ; risk factors ; database management systems
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective.A deficit is suspected in the manual documentation ofadverse events in quality assurance programs in anesthesiology. In order toverify and quantify this, we retrospectively compared the incidence ofmanually recorded perioperative adverse events with automatically detectedevents. Methods.In 1998, data of all anesthetic procedures, includingthe data set for quality assurance of the German Society of Anaesthesiologyand Intensive Care Medicine (DGAI), was recorded online with the AnesthesiaInformation Management System (AIMS) NarkoData4® (Imeso GmbH). SQL(Structured Query Language) queries based on medical data were defined for theautomatic detection of common adverse events. The definition of the SQLstatements had to be in accordance with the definition of the DGAI forperioperative adverse events: A potentially harmful change of parameters ledto therapeutic interventions by an anesthesiologist. Results.During16,019 surgical procedures, anesthesiologists recorded 911 (5.7%) adverseevents manually, whereas 2966 (18.7%) events from the same database weredetected automatically. With the exception of hypoxemia, the incidence ofautomatically detected events was considerably higher than that of manuallyrecorded events. Fourteen and a half percent (435) of all automaticallydetected events were recorded manually. Conclusion.Using automaticdetection, we were able to prove a considerable deficit in the documentationof adverse events according to the guidelines of the German quality assuranceprogram in anesthesiology. Based on the data from manual recording, theresults of the quality assurance of our department match those of othercomparable German departments. Thus, we are of the opinion that manualincident reporting seriously underestimates the true occurrence rate ofincidents. This brings into question the validity of quality assurancecomparisons based on manually recorded data.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009977917319
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