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  • 1
    Electronic Resource
    Electronic Resource
    Kreislaufwirkungen von Indigocarmin beim Menschen (1974)
    Springer
    Journal of molecular medicine 52 (1974), S. 506-508 
    Details
    ISSN: 1432-1440
    Keywords: Indigo carmine ; hemodynamics ; general anesthesia ; Indigocarmin ; Hämodynamik ; Allgemeinnarkose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An 7 Patienten wurden die Kreislaufwirkungen von Indigocarmin in klinisch üblicher Dosierung (0,07 und 0,14 ml/kg einer 0,4% igen Lösung i.v.) unter den Bedingungen einer Halothannarkose untersucht. Indigocarmin führte zu einer erheblichen Zunahme des peripheren Gefäßwiderstandes und des arteriellen Mitteldruckes, während Herzminutenvolumen, Schlagvolumen und Herzfrequenz abnahmen. Aufgrund einer nur geringfügigen Abnahme von dp/dt max und bei Berücksichtigung von preload, afterload und Herzfrequenz ist eine stärkergradige Beeinträchtigung der Myokardcontractilität durch Indigocarmin nicht anzunehmen. Die Herzarbeit (modifizierter tension-time-index) nahm zu. Die beobachteten Kreislaufwirkungen hielten länger als 20 min an. Sie rechtfertigen die Empfehlung, den Blaufarbstoff Indigocarmin bei Patienten mit Herzinsuffizienz, Hypertonus oder eingeschränkter Coronarreserve nicht zu verwenden.
    Notes: Summary In 7 patients the cardiovascular effects of intravenous indigo carmine (0.07 and 0.14 ml/kg of a 0.4% solution) were investigated under the conditions of halothane anesthesia. Indigo carmine caused a marked increase in total peripheral resistance and mean arterial pressure whereas cardiac output, stroke volume and heart rate decreased. Maximum dp/dt and load data indicate that there was no major impairment of myocardial contractility. Indigo carmine elevated cardiac work (modified tension-time-index). The duration of action exceeded 20 minutes. It is concluded that intravenous indigo carmine may be hazardous and that its use should be restricted in hypertensive patients and in the presence of cardiac insufficiency or coronary artery disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01468541
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  • 2
    Electronic Resource
    Electronic Resource
    The effects of prostacyclin on gastric intramucosal pH in patients with septic shock (1995)
    Springer
    Intensive care medicine 21 (1995), S. 414-421 
    Details
    ISSN: 1432-1238
    Keywords: Prostacyclin ; Gastric intramucosal pH ; Splanchnic blood flow ; Splanchnic oxygenation ; Septic shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To investigate whether infusing prostacyclin (PGI2) in patients with septic shock improves splanchnic oxygenation as assessed by gastric intramucosal pH (pHi). Design Interventional clinical study. Setting Surgical ICU in a university hospital. Patients 16 consecutive patients with septic shock according to the criteria of the ACCP/SCCM consensus conference all requiring norepinephrine to maintain arterial blood pressure. Interventions All patients received PGI2 (10 ng/kg·min) after no further increase in oxygen delivery could be obtained by volume expansion, red cell transfusion and dobutamine infusion. The results were compared with those before and after conventional resuscitation. The patients received continuous PGI2 infusion for 3–32 days. Measurements and results O2 uptake was measured directly in the respiratory gases, pHi was determined by tonometry. Baseline O2 delivery, O2 uptake and pHi were 466±122 ml/min·m2, 158±38 ml/min·m2, and 7.29±0.09, respectively. While O2 uptake remained unchanged, infusing PGI2 increased O2 delivery (from 610±140 to 682±155 ml/min·m2,p〈0.01) and pHi (from 7.32±0.09 to 7.38±0.08,p〈0.001) beyond the values obtained by conventional resuscitation. While 9 of 11 patients with final pHi〉7.35 survived, all patients with final pHi〈7.35 died (p〈0.01). Conclusions Infusing PGI2 in patients with septic shock increases pHi probably by enhancing blood flow to the splanchnic bed and thereby improves splanchnic oxygenation even when conventional resuscitation goals have been achieved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01707410
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  • 3
    Electronic Resource
    Electronic Resource
    Subcutaneous emphysema in a patient with bronchial asthma after general anaesthesia for transurethral resection (1999)
    Oxford : Blackwell Science Ltd
    Anaesthesia 54 (1999), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.1999.01233.x
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  • 4
    Electronic Resource
    Electronic Resource
    Antagonisteninduzierte Opiatentgiftung Erfahrungsbericht zur klinischen Anwendung sowie zum kurz- und mittelfristigen Verlauf (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 745-750 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Polytoxikomanie ; Opiatabhängigkeit ; Opiatentzugssyndrom ; Naloxoninduzierte Opiatentgiftung ; “Turbo-Entzug” ; Key words Polytoxicomania ; Opiate dependence ; Opiate withdrawal syndrome ; Naloxone-induced opiate detoxification ; Ultrarapid opiate withdrawal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In a special inpatient unit for detoxification treatment of illicit drugs, antagonist-induced opiate detoxification was studied in five nonselected inpatients with polytoxicomanic abuse. The purpose was to evaluate the feasibility of this detoxification method and its impact on further reaction to treatment. During rapid detoxification under general anesthesia in an intensive care unit, no complications occurred. Withdrawal symptoms were observed in all patients over several days. During the inpatient period, no patient could be motivated to take part in a longer rehabilitation therapy. Most patients were discharged prematurely on their own demand and none made use of the rehabilitation program offered to them. All patients relapsed after relatively short times and three out of five presented for a new detoxification treatment.
    Notes: Zusammenfassung In einer Einrichtung zur stationären niederschwelligen Entgiftung wurde an 5 nicht selektierten Patienten mit der Diagnose einer Polytoxikomanie die antagonisteninduzierte Opiatentgiftung durchgeführt. Ziel war es, die Durchführbarkeit dieses Entgiftungsverfahrens bei nicht monovalent opiatabhängigen und sozial wenig integrierten Patienten zu untersuchen und Erfahrungen über die Auswirkungen auf den Verlauf zu gewinnen. Die Intensiventgiftungsphase in Narkose verlief in allen Fällen komplikationslos. Entzugserscheinungen wurden anschließend bei allen Patienten über mehrere Tage beobachtet. Während der stationären Behandlung konnte keiner der Patienten zu einer weiterführenden Entwöhnungstherapie motiviert werden. Nach Entlassung aus der stationären Behandlung, die zumeist vorzeitig auf Wunsch der Patienten erfolgte, wurde das ambulante Behandlungsangebot nicht genutzt. Im weiteren Verlauf erlitten alle Patienten nach relativ kurzer Zeit einen Rückfall; 3 von 5 stellten sich zu einer erneuten Entgiftungsbehandlung vor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050659
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  • 5
    Electronic Resource
    Electronic Resource
    Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS (1990)
    Springer
    Intensive care medicine 16 (1990), S. 227-232 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Pulmonary hypertension ; Right ventricular function ; Right ventricular ejection fraction ; Thermodilution ; Prostacyclin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2, 12.5–35.0 ng·kg−1·min−1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI2 infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI2 reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p〈0.01). The cardiac index (CI) increased from 4.2 to 5.81·min−1·m−2 (p〈0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg·min·m2·1−1,p〈0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%,p〈0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r=0.789, Δ% RVEF=−2.11·ΔPVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p〈0.05) the arterial PO2 remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min−1·m−2 (p〈0.01). We conclude that short term infusions of PGI2 increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI2 may be useful to lower pulmonary artery pressure in ARDS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01705156
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  • 6
    Electronic Resource
    Electronic Resource
    Fat emulsions containing medium chain triglycerides in patients with sepsis syndrome: Effects on pulmonary hemodynamics and gas exchange (1992)
    Springer
    Intensive care medicine 18 (1992), S. 231-234 
    Details
    ISSN: 1432-1238
    Keywords: Sepsis syndrome ; Fat infusion ; Medium chain triglycerides ; Prostaglandin ; Ventilation/perfusion distributions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Fat emulsions containing medium chain triglycerides (MCT) have recently been introduced into clinical practice as a component of total parenteral nutrition. Since several authors reported increased pulmonary artery pressure and impaired gas exchange during intravenous (i.v.) fat use, in particular in septic patients, we studied the pulmonary hemodynamic and gas exchange effects of i.v. fat containg MCT and long chain triglycerides (LCT) in patients with sepsis syndrome. As the effects of fat emulsions have been attributed to increased formation of prostanoids, the production of thromboxane A2 and prostacyclin was investigated by the determination of urinary thromboxane B2 and 6-keto-prostaglandin F2α, respectively. The i.v. fat use did not induce any alterations in pulmonary hemodynamics and gas exchange, the distribution of ventilation and perfusion nor urinary probably content. We conclude that fat emulsions containing MCT induce little alterations in pulmonary hemodynamics and gas exchange. This result is probably due to reduced prostaglandin formation because fat emulsions containing MCT provide less prostaglandin precursors than pure LCT emulsions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709838
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  • 7
    Electronic Resource
    Electronic Resource
    Blood pH and $$P_{aCO_2 } $$ as chemical factors in myocardial blood flow control (1975)
    Springer
    Basic research in cardiology 70 (1975), S. 685-696 
    Details
    ISSN: 1435-1803
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An intakten Hunden wurde der Einfluß einer isolierten metabolischen Azidose (HCl-Infusion, n=12) auf die Myokarddurchblutung mit den Koronarwirkungen einer durch Hyperkapnie induzierten Azidose (Beatmung mit 5% CO2, n=5) unter den Bedingungen einer Allgemeinnarkose verglichen. Eine metabolische Azidose führte (bei normalen arteriellen Kohlensäuredrucken) unterhalb eines pH-Wertes von 7,2 zu einer Steigerung der Koronardurchblutung, zu einer Abnahme des Koronarwiderstandes und der arterio-koronarvenösen Sauerstoffgehaltsdifferenz, d. h., zu einer primären Koronardilatation bei gleichbleibendem myokardialem Sauerstoffverbrauch. Da sich dieser Effekt bei Tieren, die mit Propranolol vorbehandelt waren, nicht nachweisen ließ, ist anzunehmen, daß eine β-Stimulation unter den gegebenen Versuchsbedingungen mittelbar oder unmittelbar wesentlichen Anteil an den Koronarwirkungen einer metabolischen Azidose hat. Unter den Bedingungen einer Hyperkapnie wurde ebenfalls eine Koronardilatation beobachtet, diese war jedoch deutlich stärker ausgeprägt als bei gleich großer Säuerung mit HCl und ließ sich durch Vorbehandlung mit Propranolol nicht blockieren. Diese Befunde lassen den Schluß zu, daß die koronardilatierende Wirkung hoher arterieller Kohlensäuredrücke nicht auf eine β-adrenerge Stimulation zurückzuführen ist und unabhängig von der begleitenden Zunahme der Wasserstoffionenkonzentration auftritt. Der Wirkungsort wird diskutiert.
    Notes: Summary The effect of metabolic and hypercapnic acidosis on myocardial blood flow was studied during intravenous infusions of hydrochloric acid solutions (n=12) and during passive ventilation with 5% CO2 (n=5) in anaesthetized, closed chest dogs. Below a pH of 7.2 metabolic acidosis at normal arterial CO2-tensions caused an increase of coronary blood flow and a decrease of coronary vascular resistance associated with a narrowed myocardial arteriovenous O2-difference, indicating vasodilation at unchanged myocardial oxygen consumption. In propranolol-pretreated dogs myocardial blood flow and coronary oxygen AV difference remained unaffected, suggesting that the coronary dilatory effect of metabolic acidemia involves beta adrenergic stimulation. Coronary vasodilation induced by increasing arterial pCO2 was found to the significantly greater as compared with the dilatory effect of metabolic acidosis at the same blood pH level. Blocking of beta receptors did not reduce the coronary response to increased arterial CO2-tensions. It is concluded that the coronary vasodilation observed during hypercapnic acidosis is neither mediated by a beta adrenergic stimulation nor dependent of the concomitant change in blood pH. The possible sites of the coronary dilatory actions of increased arterial CO2-tensions are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01906477
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  • 8
    Electronic Resource
    Electronic Resource
    Hemodynamic interactions of hemodilution, anaesthesia, propranolol pretreatment and hypovolaemia I. Systemic circulation (1979)
    Springer
    Basic research in cardiology 74 (1979), S. 109-122 
    Details
    ISSN: 1435-1803
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The influence of anaesthetic agents and propranolol pretreatment on the adequacy of cardiovascular adjustment to progressive normovolaemic hemodilution and to the combination of anaemia and blood loss was studied in a total of 18 dogs which were divided into 3 groups of 6 dogs each. One group received neuroleptanalgesia, the second group was anaesthetized with halothane (1%), group three received halothane (1%) and was pretreated with propranolol (0.5 mg/kg). Acute isovolaemic anaemia was produced by a stepwise exchange of blood with 6% dextran. The total exchange volume was 70 ml/kg which was associated with a decrease of mean hematocrit values from about 45% to 16%. Cardiac output rose continuously with progressive hemodilution, the maximum percentage increases were 39% in the neuroleptanalgesia-group, 59% in the halothane-group and in the animals with halothane anaesthesia and propranolol pretreatment. These changes were due to increases in both heart rate and stroke volume, the greatest percent rise in stroke index (36%) and the least change in heart rate (+18%) being observed in the propranolol-treated dogs. Apart from a small overshoot of the systemic oxygen availability during the initial stages of exchange transfusion in the neuroleptanalgesia- and halothane-group, the reduced arterial oxygen content was not compensated by the increase in cardiac output. Consequently, there was a continuous reduction of the systemic oxygen transport capacity with a maximum decrease of about 40% in either group. Systemic oxygen uptake was maintained over a wide range of hematocrits by an increased extraction of oxygen from blood. Mean arterial pressure essentially remained unaffected in each of the groups, the changes in total peripheral resistance were inverse to that of cardiac output and showed little differences between the three groups in response to exchange transfusions. Left ventricular dP/dt values, left ventricular volumes and ejection fractions indicated an improved ventricular performance and a participation of the Frank-Starling mechanism in the response of the heart to isovolaemic hemodilution. The combination of hemodilution and limited blood loss (15 ml/kg) led to a significant reduction in arterial pressure and cardiac output, but all dogs tolerated this amount of hemorrhage and there was no indication of critical impairment of cardiac performance in any of the 3 groups. No major changes of the acid-base status were observed throughout the study. Thus, the adjustment of the normal cardiovascular system to acute normo- and hypovolaemic hemodilution appeared to be largely independent of the type of anaesthesia and of the presence or absence of betareceptor blockade.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01907814
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  • 9
    Electronic Resource
    Electronic Resource
    Hemodynamic interactions of hemodilution, anaesthesia, propranolol pretreatment and hypovolaemia II: Coronary circulation (1979)
    Springer
    Basic research in cardiology 74 (1979), S. 123-130 
    Details
    ISSN: 1435-1803
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The adequacy of myocardial oxygen supply was studied during acute progressive isovolaemic hemodilution and during the combination of anaemia and blood loss under three different anaesthetic conditions: neuroleptanalgesia (6 dogs), halothane anaesthesia (1%, 6 dogs) and halothane anaesthesia (1%) plus propranolol (0.5 mg/kg) pretreatment (6 dogs). Acute isovolaemic anaemia was produced by a stepwise exchange of blood with 6% dextran leading to a decrease of the mean hematocrit values from about 45% to about 16%. Myocardial blood flow increased by 224% in the neuroleptanalgesia-group, by 179% in the halothane-group and by 143% in the halothane plus propranolol-group. The changes in MBF were accompanied by a corresponding fall in coronary vascular resistance. Coronary sinus oxygen saturations slightly decreased but remained within the physiological range in each of the three groups. Left ventricular oxygen consumption continuously rose in the dogs with neuroleptanalgesia, the maximum increase was 32%. Only small changes of the myocardial O2-consumption were observed in the halothane-group during moderate degrees of anaemia. LV $$\dot VO_2 $$ in this group significantly increased only when the hematocrit was 20% or less. No significant changes of the left ventricular oxygen consumption occurred in the animals which had received halothane anaesthesia and were pretreated with propranolol. Myocardial lactate extraction decreased but never reached critically low values. The coronary dilatory capacity was shown not to be exhausted under any anaesthetic condition. About 30–40% of this capacity remained at hematocrit values between 10 and 15%. The combination of hemodilution and limited blood loss (15 ml/kg) led to a significant fall in myocardial blood flow and oxygen consumption, coronary vascular resistance tended to increase. Coronary sinus oxygen saturation and myocardial lactate extraction changed little in response to the combination of hemodilution and blood loss, indicating that aerobic metabolism was maintained under any anaesthetic condition used in this study.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01907815
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