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  • 1
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    Deadly diving? Physiological and behavioural management of decompression stress in diving mammals (2012)
    Royal Society
    Details
    Publication Date: 2022-05-25
    Description: © The Author(s), 2011. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Proceedings of the Royal Society B Biological Sciences 279 (2012): 1041-1050, doi:10.1098/rspb.2011.2088.
    Description: Decompression sickness (DCS; ‘the bends’) is a disease associated with gas uptake at pressure. The basic pathology and cause are relatively well known to human divers. Breath-hold diving marine mammals were thought to be relatively immune to DCS owing to multiple anatomical, physiological and behavioural adaptations that reduce nitrogen gas (N2) loading during dives. However, recent observations have shown that gas bubbles may form and tissue injury may occur in marine mammals under certain circumstances. Gas kinetic models based on measured time-depth profiles further suggest the potential occurrence of high blood and tissue N2 tensions. We review evidence for gas-bubble incidence in marine mammal tissues and discuss the theory behind gas loading and bubble formation. We suggest that diving mammals vary their physiological responses according to multiple stressors, and that the perspective on marine mammal diving physiology should change from simply minimizing N2 loading to management of the N2 load. This suggests several avenues for further study, ranging from the effects of gas bubbles at molecular, cellular and organ function levels, to comparative studies relating the presence/absence of gas bubbles to diving behaviour. Technological advances in imaging and remote instrumentation are likely to advance this field in coming years.
    Description: This paper and the workshop it stemmed from were funded by the Woods Hole Oceanographic Institution Marine Mammal Centre.
    Keywords: Diving physiology ; Marine mammals ; Gas bubbles ; Embolism ; Decompression sickness
    Repository Name: Woods Hole Open Access Server
    Type: Article
    Format: application/pdf
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    PAPER (OA)
  • 2
    Electronic Resource
    Electronic Resource
    Postoperative Analgesie bei Kindern nach Hernioplastie Wundinstillation mit verschiedenen Konzentrationen von Bupivacain: eine Pilotstudie (1999)
    Springer
    Der Anaesthesist 48 (1999), S. 439-443 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Hernioplastie ; Wundinstillation ; Bupivacain ; Postoperative Schmerztherapie ; Kinderchirurgie ; Key words Hernioplasty ; Wound instillation ; Bupivacaine ; Postoperative pain therapy ; Pediatric surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Wound instillation seems to be an easy and preferable way to achieve postoperative analgesia in pediatric hernioplasty. This prospective, randomized and double-blinded pilot-study was initiated to gain preliminary information in order to define the appropriate concentration of local anaesthetic for efficient posthernioplastic analgesia. Method: 29 children aged 3.1 to 13.7 (5.25 (3.8–8.2) years were randomly assigned to receive either 0.2 ml/kg bupivacaine 0.125% (n = 10), bupivacaine 0.25% (n = 10) or bupivacaine 0.5% (n = 9). The local anesthetic (LA) was instillated intraoperatively before wound closure above the external oblique muscle and below Scarpa’s fascia. After entering the post-anesthetic care unit (PACU) pain was assessed by a trained nurse using the linear analogue pain scale (LAPS) in intervals of 15 min. Patients were observed in the PACU for 30–60 min. Pain was further evaluated for 5.5(3–6) h in the ward every hour. In day-only patients the parents were contacted 24 h postoperatively to obtain additional information. Results: From the beginning of the observation period the 0.5% group tended to have less pain than the others in the PACU. The 0.125% and 0.25% group required earlier supplementary analgetics. In addition, the 0.5% group needed once (1/9) supplementary analgesics, the 0.25% group five times (5/10) and the 0.125% group six times (6/10). None of these results is statistically significant, though they appear to be clinically relevant. Discussion: Wound instillation with 0.2 ml of bupivacaine 0.5% seems to be easy to perform, safe and efficient in controlling posthernioplastic pain. Because of the small numbers of patients included however, no statistically significant differences were observed between the groups. Neither in the LAPS on arrival and observation at the PACU nor in the need for supplementary analgesics. Despite lacking significance the clinical impression suggests a difference to be validated by larger studies. Our data implies that wound instillation with 0.2 ml/kg bupivacaine 0.5% should be regarded for routine usage.
    Notes: Zusammenfassung Zielsetzung: Nach Operation einer Hernia inguinalis mit oder ohne Hydrozele wurde eine Wundinstillation mit jeweils 0,2 mg/kg Bupivacain 0,125, 0,25 oder 0,5% durchgeführt, um die benötigte Konzentration an lokalem Betäubungsmittel für eine suffiziente postoperative Analgesie zu ermitteln. Methodik: 29 Kinder im Alter von 3–13 Jahren wurden in diese prospektive, randomisierte Doppelblindstudie aufgenommen. Ergebnisse: Nach Gabe von 0,5% Bupivacain zeigten die Patienten postoperativ zwar später und weniger Bedarf an zusätzlichem Schmerzmittel (Paracetamol supp.) als bei Verwendung von Bupivacain 0,125 oder 0,25% mit p = 0,71 wurde jedoch keine Signifikanz erreicht. Aufgrund einer effizienten Schmerztherapie mit peripheren Analgetika veränderten sich die mittels einer linearen analogen Schmerzskala (LAPS) beurteilten Schmerzwerte der Patienten im Verlauf zumeist gleichartig. Eine stärkere analgetische Potenz von Bupivacain 0,5% gegenüber den geringeren Konzentrationen deutet sich an, durch die geringen Fallzahlen (pro Gruppe 9–10 Patienten) ist sie nicht signifikant. Schlußfolgerung: Die Wundinstillation ist sicher, technisch einfach und effektiv. Nach Bestätigung im Rahmen von größeren Folgestudien sollte sie sich als Alternative zu invasiveren Verfahren in der postoperativen Schmerztherapie etablieren können.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050727
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  • 3
    Electronic Resource
    Electronic Resource
    Klinische Aspekte des akuten Lungenversagens des Erwachsenen (ARDS) (1996)
    Springer
    Der Anaesthesist 45 (1996), S. 2-18 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Acute respiratory distress syndrome (ARDS) ; extrakorporale Membranoxygenierung (ECMO) ; Überlebensraten ; Beatmung ; PEEP ; permissive Hyperkapnie ; Stickstoffmonoxid (NO) ; Key words Acute respiratory distress syndrome ; Extracorporeal membrane oxygenation ; Survival rates ; Mechanical ventilation ; PEEP ; Permissive hypercapnia ; Nitric oxide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Acute respiratory distress syndrome (ARDS) is rare but beset with a high mortality rate. In recent years, however, a trend towards higher survival rates has been observed. High inspiratory oxygen concentrations, large tidal volumes, and high peak inspiratory airway pressures applied during mechanical ventilation have been identified as harmful to the lung and can contribute to the progression of ARDS. This had led to reconsideration of the sequelae of ventilatory therapy. Mechanical ventilation and other adjunctive strategies in ARDS have changed from the conventional approach aiming at normalisation of physiological ventilatory parameters to an elaborated approach that intends to protect the ventilated lung, prevent oxygen toxicity, recruit the infiltrated atelectatic and consolidated lung and reduce the anatomical and alveolar dead space. This new approach consists of various forms of pressure-controlled mechanical ventilation with PEEP and permissive hypercapnia, body position changes, and inhalation of nitric oxide. Should these procedures fail to improve impaired gas exchange, extracorporeal membrane oxygenation is an additional therapeutic option. None of these therapeutic procedures, however, has been tested against traditional standard treatment in a classical randomised controlled trial. The following review focuses on the latest insights into the pathophysiology, diagnosis, and treatment of ARDS.
    Notes: Zusammenfassung Das akute Lungenversagen des Erwachsenen ist selten, aber auch heute noch mit einer sehr hohen Letalität belastet, wenngleich sich in den letzten Jahren ein Trend zu verbesserten Überlebensraten abzuzeichnen beginnt. Neuere Studien haben gezeigt, daß die bis vor kurzem noch in der Behandlung des ARDS angewendete Beatmungstherapie mit großen Atemzugvolumina, hohen Beatmungsdrücken und hohen inspiratorischen Sauerstoffkonzentrationen die erkrankte Lunge weiter schädigen kann. Diese Erkenntnisse haben zu einem Umdenken in der Behandlung geführt. Vorrangiges Ziel ist heute nicht mehr, die Wiederherstellung und Aufrechterhaltung physiologischer Normwerte für Sauerstoff- und Kohlendioxidpartialdrücke sowie arteriellen pH zu erreichen, sondern die Lunge vor beatmungsinduzierten Schäden zu schützen. Hierzu hat sich ein erweitertes Behandlungskonzept, bestehend aus verschiedenen Formen der drucklimitierten Beatmung mit PEEP und permissiver Hyperkapnie, Lagerungsmaßnahmen, Inhalation von Stickstoffmonoxid und – zumindest in Europa – extrakorporaler Membranoxygenierung als erfolgreich erwiesen, ohne daß die Effizienz jeder einzelnen Methode in kontrollierten randomisierten Studien bewiesen worden wäre. In dem vorliegenden Übersichtsartikel werden die neuesten Entwicklungen aufgezeigt, diskutiert und im Hinblick auf ihre klinische Effizienz bewertet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050234
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  • 4
    Electronic Resource
    Electronic Resource
    Die Relevanz perioperativer Gerinnungsparameter für die Indikation von Bluttransfusionen (1994)
    Springer
    Der Anaesthesist 43 (1994), S. 168-177 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Lebertransplantation – Blutgerinnung – Bluttransfusion – Hämodynamik – Statistik ; Key words: Liver transplantation – Coagulation – Transfusion – Haemodynamics – Statistics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. In the present study, a retrospective statistical analysis of laboratory data, clinical data, and perioperative blood requirements from 300 primary orthotopic liver transplantations (OLT) is described. Methods. OLT was performed using established surgical techniques and total IV anaesthesia. Volume was substituted with red blood cells (RBC) and fresh frozen plasma (FFP) according to haemodynamic data, haemoglobin, and diuresis. Platelet counts, prothrombin time, activated partial thromboplastin time (aPTT), thrombin time, fibrinogen, and antithrombin III were registered but not used as indications for transfusions. Statistics were performed using regression analysis and analysis of variance. Results. The mean intraoperative fluid requirement was 793 ml balanced salt solution, 7.1 units RBC, and 8.4 units FFP; pooled random donor platelets were given only once. During 24 h postoperatively, an average of 1.8 units RBC and 4.6 units FFP had to be transfused. Currently, 278 of the 300 patients (92.7%) are alive. There was no significant correlation between clotting data and intraoperative blood use; for postoperative transfusion rates, the preoperative aPTT and postoperative platelet counts had a significant correlation. Reviewing the basic diseases of the patients, there were significant differences in coagulation status, but no differences in transfusion rates. Conclusion. According to the data presented, indications for transfusions in OLT according to clotting data are not valid, since these data do not correlate with the blood requirement. In addition, strategies for pretreatment of patients such as preoperative plasmapheresis are no longer justified with respect to possible side effects.
    Notes: Zusammenfassung. Ein Problem bei der Analyse von Transfusionsdaten ist die uneinheitliche Indikationsstellung: der geschätzte Blutverlust, perioperative Labordaten und/oder hämodynamische Parameter werden hierbei je nach Ausbildung des Anästhesisten und seiner persönlichen Bewertung herangezogen. Bei orthotopen Lebertransplantationen, die sich durch massive Entgleisungen des Gerinnungssystems und einen hohen Transfusionsbedarf auszeichnen, scheint diesbezüglich die Tendenz zu bestehen, durch ein zunehmend perfektioniertes perioperatives Monitoring der Gerinnung die Indikation zu Transfusionen nach Labordaten und weniger nach der Klinik des Patienten zu richten. Die aktuellen medizinischen, ethisch-rechtlichen und nicht zuletzt auch finanziellen Aspekte bei der Übertragung von Fremdblut ließen eine diesbezügliche Studie sinnvoll erscheinen. Nach 300 Lebertransplantationen, bei denen zur Indikation von Bluttransfusionen hämodynamische Parameter, Diurese und Hämoglobin herangezogen wurden, wurde festgestellt, daß 1) die perioperativen Gerinnungsparameter nicht mit dem Transfusionsbedarf korrelierten, 2) der Transfusionsbedarf vergleichsweise niedrig gehalten werden konnte, und 3) auch postoperativ kein erhöhter Transfusionsbedarf entstand. Die Relevanz perioperativer Gerinnungsdaten für die Indikation von Bluttransfusionen bei Lebertransplantationen muß daher auch weiterhin als fraglich eingeschätzt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050045
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  • 5
    Electronic Resource
    Electronic Resource
    From the new editor! (1995)
    Springer
    Intensive care medicine 21 (1995), S. 99-100 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01726529
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  • 6
    Electronic Resource
    Electronic Resource
    Cardiac afferents and the renal response to positive pressure ventilation in the dog (1986)
    Springer
    Intensive care medicine 12 (1986), S. 147-152 
    Details
    ISSN: 1432-1238
    Keywords: Cardiac afferents ; Denervation of the heart ; Controlled mechanical ventilation ; Positive airway pressure ; Kidney function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of cardiac denervation on renal function during spontaneous breathing (SB) and controlled mechanical ventilation (CMV) were investigated in six mongrel dogs. Selective and reversible blockade of cardiac afferents was achieved by instillation of procaine 2% into the pericardium. Application of procaine 2% into the pericardium during SB caused a statistically significant depression of urine flow (-55%), of sodium (-64%) and potassium excretion (-42%), and of inulin (-21%) and PAH-clearance (-30%). After institution of CMV with a positive end-expiratory pressure (PEEP) of 10 cm H2O a further, statistically significant decrease in urine flow (-42%) and sodium excretion (-70%) and of the inulin (-15%) and PAH-clearance (-38%) was observed. Global hemodynamics, mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP) and cardiac index (CI) did not change significantly after installing procaine 2% into the pericardium during SB. After institution of CMV an increase in CVP and MPAP occurred whereas MAP and CI remained unchanged. During the following periods of spontaneous breathing first with blockade of cardiac afferents and later after washing out the procaine with NaCl 0.9% all parameters of renal function approached control levels as measured in the first period of spontaneous breathing without cardiac denervation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00254930
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  • 7
    Electronic Resource
    Electronic Resource
    Pressure and volume assessment of right ventricular function during mechanical ventilation (1988)
    Springer
    Intensive care medicine 14 (1988), S. 467-470 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00256961
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  • 8
    Electronic Resource
    Electronic Resource
    Facilitation of renal function by intermittent mandatory ventilation (1984)
    Springer
    Intensive care medicine 10 (1984), S. 59-65 
    Details
    ISSN: 1432-1238
    Keywords: Intermittent mandatory ventilation ; Controlled mechanical ventilation ; Positive endexpiratory pressure ; Renal excretory function, renal perfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effects of intermittent mandatory ventilation (IMV) and controlled mechanical ventilation (CMV) on excretory function and the hemodynamics of the kidneys were studied in two groups of anaesthetized dogs during periods of 3 and 4 h. IMV was associated with statistically significant improved urinary output and renal plasma flow of approximately 50 and 35%, respectively. Graphical and statistical analysis revealed certain cross-over effects indicating that the beneficial effect of IMV was more pronounced if it was used following CMV. The improvements in renal function were interpreted as consequences of decreased mean intrathoracic pressures during IMV as compared to CMV. A correlation to global hemodynamic changes could not be established. IMV does facilitate kidney function and hence may successfully counteract the retention of water and salt which occurs during prolonged mechanical ventilation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00297559
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  • 9
    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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  • 10
    Electronic Resource
    Electronic Resource
    Tracheal and alveolar gas composition during low-frequency positive pressure ventilation with extracorporeal CO2-removal (LFPPV-ECCO2R) (1985)
    Springer
    Intensive care medicine 11 (1985), S. 213-217 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Alveolar gas composition ; Low frequency positive pressure ventilation with extracorporeal CO2-removal ; Mass spectrometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Tracheal and alveolar gas composition was studied by mass spectrometry in a patient with severe ARDS treated by low frequency positive pressure ventilation/extracorporeal CO2-removal (LFPPV-ECCO2R). Measured alveolar gas concentrations were compared with values derived from standard respiratory equations. As a result we found that during LFPPV-ECCO2R with a constant endotracheal O2-flow, alveolar gas composition cannot be predicted reliably from standard equations. The reasons for this finding are discussed. We conclude that monitoring of alveolar gas composition by mass spectrometry is of great value during LFPPV-ECCO2R if PAO2, P(A-a)O2 and Qva/Qt are to be determined correctly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00272408
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