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  • 1
    Electronic Resource
    Electronic Resource
    C1840-T mutation in the human skeletal muscle ryanodine receptor gene: frequency in northern German families susceptible to malignant hyperthermia and the relationship to in vitro contracture response (1995)
    Springer
    Journal of molecular medicine 73 (1995), S. 35-40 
    Details
    ISSN: 1432-1440
    Keywords: Malignant hyperthermia ; Ryanodine receptor gene ; C1840-T mutation ; In vitro contracture test ; Human skeletal muscle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In swine, a point mutation in the ryanodine receptor gene can account for all cases of malignant hyperthermia (MH). The frequency of a corresponding mutation in humans (C1840-T) and its relationship to the in vitro contracture profile is unknown. We screened 192 patients from 28 unrelated northern German families for the C1840-T mutation in the human ryanodine receptor gene and tested for MH susceptibility using the in vitro contracture test (IVCT) according to the European MH Protocol. In our patients 106 revealed MH susceptible (MHS), 56 MH nonsusceptible and 30 MH equivocal status following IVCT. In each family one or two individuals had developed clinical signs of MH or a MH crisis. All of these patients were classified MHS. The C1840-T mutation was found in 2 of 28 families (7.1%). All eight individuals of the two families characterized by this mutation revealed MHS status following IVCT. The thresholds for halothaneand caffeine-induced contractures as well as the contracture profiles following cumulative (0.4–10.0 μmol/l every 3 min) and bolus (10 μmol/l) administration of ryanodine were found to be similar in MHS patients with and without the C1840-T mutation. In conclusion, the C1840-T mutation in the human ryanodine receptor gene is a rare abnormality in MHS families. Similar contracture profiles in the presence and absence of this mutation might imply no major functional role with respect to the contracture response. At present, molecular genetic analysis cannot replace IVCT to discover MH susceptibility in humans.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00203617
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  • 2
    Electronic Resource
    Electronic Resource
    Effekte von Serotonin2Rezeptoragonisten auf Skelettmuskelpräparate von Patienten mit Disposition zu maligner Hyperthermie (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 538-544 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Maligne Hyperthermie ; Halothan ; Koffein ; Serotonin ; in vitro-Kontrakturtest ; Key words Malignant hyperthermia ; Halothane ; Caffeine ; Serotonin ; In vitro contracture test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In pigs genetically susceptible to malignant hyperthermia (MH), it has been shown that serotonin (5-HT2) receptor agonists can induce MH and “psychotic” behaviour. Both can be prevented by 5-HT2 receptor antagonists. Furthermore, free levels of serotonin in plasma increased concomitantly with clinical and laboratory parameters during halothane-induced MH in pigs. In this study the in vitro-effects of the 5-HT2 receptor agonist1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) were investigated in muscle specimens of MH-susceptible (MHS) and normal (MHN) patients. Methods. Muscle biopsies were obtained from 37 patients aged 5–69 years (23.6±5.3 years) with clinical suspicion for MH. The patients were first classified as MHS, MHN or MHE (MH equivocal) by the in vitro contracture test (IVCT) according to the European MH protocol. After MH classification, surplus muscle specimens were subjected to the DOI study. DOI was added to the organ bath in a concentration of 0.02 mmol/l. The in vitro effects on contracture development and muscle twitch were observed for 120 min. Results. Muscle specimens of all patients developed contractures after administration of DOI. However, DOI produced an earlier development of contracture in MHS (17.0±1.8 min; n=17) than in MHN (64.7±5.9 min; n=15) muscles. In MHS muscles, contractures were more distinct than in MHN muscles; at the end of the experiment, contractures had reached a maximum of 12.5±0.9 mN in MHS and 5.1±0.7 mN in MHN muscles. Muscle twitch following DOI administration was reduced significantly in both MHS and MHN muscles. The results of four MHE muscles were comparable with MHS. Conclusion. The present study supports the assumption that an altered serotonin system might be involved in the development of MH. In further studies it should investigated whether 5-HT2 receptors of skeletal muscles from MHS subjects are disordered in function or structure. 5-HT2 receptor agonists should be considered as MH-triggering agents.
    Notes: Zusammenfassung Im Tierexperiment löste die Applikation von Agonisten für Serotonin 2 -Rezeptoren eine maligne Hyperthermie (MH) aus, Antagonisten konnten hingegen die Entwicklung einer MH beim Schwein verhindern. In einer weiteren Studie wurde ein Anstieg des Serotonins im Plasma während einer Halothan-induzierten MH beim Schwein nachgewiesen. Ziel dieser Untersuchung war die Registrierung der in vitro-Effekte des Serotonin 2 -Rezeptoragonisten 1-(2,5-Dimethoxy-4-Iodophenyl)-2-Aminopropan (DOI) auf menschliche Skelettmuskelpräparate von MH-Anlageträgern (MHS) und Nichtanlageträgern (MHN). Nach Gabe von 0,02 mmol/l DOI entwickelten die Muskelpräparate aller 37 Patienten Kontrakturen. Allerdings begann in der MHS-Gruppe (n= 17) die Kontrakturentwicklung mit 17,0±1,8 min signifikant früher als in der MHN-Gruppe (64,7± 5,9 min; n=15). Die Kontrakturen der MHS-Muskeln waren signifikant stärker als in der Vergleichsgruppe. Am Ende des Beobachtungszeitraums von 120 min wurde ein Kontrakturmaximum von 12,5±0,9 mN bei MHS- und von 5,1±0,7 mN bei MHN-Muskeln registriert, die Muskelkontraktionskraft zeigte sich in beiden Gruppen signifikant reduziert. Die Ergebnisse von vier als MHE klassifizierten Muskeln waren vergleichbar mit denen der MHS-Muskeln. Die vorgelegte Studie unterstützt die Vermutung, daß bei der MH ein verändertes Serotoninsystem ursächlich beteiligt sein könnte. In weiteren Studien sollte untersucht werden, ob Serotonin 2 -Rezeptoren der Skelettmuskulatur von MHS Individuen in ihrer Funktion oder Struktur alteriert sind. Serotonin 2 -Rezeptoragonisten sollten als Triggersubstanzen der MH gelten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050186
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  • 3
    Electronic Resource
    Electronic Resource
    Postoperatives Erbrechen Ein Score zur Voraussage des Erbrechensrisikos nach Inhalationsanaesthesien* (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 732-740 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Postoperative Übelkeit und postoperatives Erbrechen ; Inhalationsanästhesie ; Prädiktion ; Risikoscore ; Key words Postoperative nausea and vomiting ; PONV ; Prediction ; Risk score
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Despite numerous factors are thought to affect postoperative vomiting (PV) recent studies demonstrated that the risk of PV can be predicted by considering just the most important ones. Therefore, the aim of this study was to present the clinically most relevant factors, a risk score based upon those factors and its clinical applicability for other types of surgery. Methods: In a prospective study 2220 adult inpatients scheduled for elective surgery were monitored for PV after inhalational anaesthesia over 24 hours. None of the patients received prophylactic antiemetic treatment. Multivariate analyses were perfomed with data of patients who underwent otolaryngological procedures to identify the major risk factors and to derive a risk score. The applicability of the score in surgical and ophthalmological procedures was tested by linear regression analysis of expected and observed incidences. Results: In the multivariate model, clinically most important risk factors for PV were female gender, young age, a positive history of postoperative nausea and vomiting or motion sickness, non-smoking and a long duration of anaesthesia, whereas the relative impact of the ”type of operation itself” was small. Expected and observed incidences in patients undergoing other types of surgery were strongly correlated (R2=0.99, P〈0.001). Conclusion: The risk for PV after inhalational anaesthesia in adults can be predicted using a score which is based on individual risk factors and the duration of anaesthesia only.
    Notes: Zusammenfassung Trotz der multifaktoriellen Genese postoperativen Erbrechens (PE) konnte jüngst gezeigt werden, daß das PE-Risiko anhand weniger Faktoren abgeschätzt werden kann. Ziel dieser Arbeit war daher, die klinisch relevanten Faktoren darzustellen, einen daraus abgeleiteten Score vorzustellen und dessen praktische Anwendbarkeit zu demonstrieren. Methodik: Im Rahmen einer prospektiven Studie erhielten 2220 Patienten eine Inhalationsanästhesie ohne antiemetische Prophylaxe. Mittels einer multivariaten Analyse der Patientendaten der HNO-Klinik wurden klinisch relevante Faktoren herausgearbeitet und ein Risikoscore errechnet. Die Anwendbarkeit dieses Scores auf Patienten der Chirurgie und Augenklinik wurde mittels linearer Regression zwischen erwarteter und tatsächlicher Inzidenz überprüft. Ergebnisse: Die wichtigsten Risikofaktoren für PE waren weibliches Geschlecht, junges Alter, Übelkeit und Erbrechen nach Operationen oder eine Reisekrankheit in der Anamnese, Nichtraucherstatus und eine lange Narkosedauer. Obgleich primär einige Operationen mit hohen und andere mit niedrigen Erbrechensinzidenzen einhergingen, war in einem multivariaten Modell der Einfluß der ”Operation an sich” gegenüber den zuvor erwähnten Risikofaktoren gering. Bei der Anwendung des Risikoscores auf andere Operationen zeigte sich eine signifikante Korrelation zwischen erwarteter und tatsächlicher Inzidenz (r2=0,99, p〈0,001). Schlußfolgerungen: Die Wahrscheinlichkeit, mit der bei einem Erwachsenen nach Inhalationsanästhesien PE auftritt, läßt sich anhand individueller Risikofaktoren sowie der Narkosedauer voraussagen. Die bekannten Unterschiede zwischen verschiedenen Operationen sind vor allem durch die zuvor beschriebenen Faktoren bedingt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050620
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  • 4
    Electronic Resource
    Electronic Resource
    Abschätzung akuter linksventrikulärer Nachlaständerungen (1995)
    Springer
    Der Anaesthesist 44 (1995), S. 108-115 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Echokardiographie ; transösophageal ; Herz ; linksventrikulär ; Nachlast ; Funktion ; Key words Echocardiography ; transoesophageal ; Heart ; left ventricle ; Afterload ; Function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Left ventricular afterload is most accurately represented by left ventricular end-systolic wall stress, but in clinical practice is commonly estimated by the systemic vascular resistance (SVR). End-systolic wall stress can be derived from M-mode and two-dimensional (2D) echocardiograms in combination with systolic arterial pressure (SAP). We tested transoesophageal echocardiography for the assessment of acute left ventricular afterload alterations in ventilated patients requiring cardiovascular support with noradrenaline or nitroglycerine. Method. With approval from the local ethics committee, we studied afterload alterations in 11 hypotensive patients who were treated by increasing the dosage of IV noradrenaline by 2–5 μg/min in order to raise mean arterial pressure (MAP) by 20 mmHg. In another 10 patients with MAP over 95 mmHg, nitroglycerine was raised from 2 to 4 mg/h, aiming at a 20 mmHg MAP reduction. MAP and SAP were monitored via a radial artery cannula, cardiac output (CO) was measured with the thermodilution technique using a Swan-Ganz catheter, and SVR was calculated from CO, MAP, and right atrial pressure. M-mode and 2D echocardiograms were obtained from the cross-sectional short-axis view of the left ventricle and recorded shortly before and during treatment when MAP had changed by 20 mmHg. Left ventricular total area (TA) and cavity area (A) including the papillary muscles were obtained from end-systolic 2D echocardiograms, while end-systolic internal diameter (ID) and posterior wall thickness (HW) were measured in the M-mode. Wall stress was calculated in the M-mode as: WSM=0.33 · SAP · ID/(HW · (1+HW/ID)), and in the 2D mode as: WS2D=1.33 · SAP · A/(TA-A). Statistics: paired t-test (P〈0.05), regression analysis. Results. Afterload alterations were reflected by significant changes of WS2D (―41%, +68%), WSM (―26%, +38%), and SVR (―15%, +50%). WSM and SVR underestimated changes of WS2D by 15%–30%. WSM changes due to SAP rather than to left-ventricular dimensional changes. No correlation was found between WS2D or WSM and SVR. Inter-observer variability for echocardiographic wall stress was reasonable (WS2D 4%, WSM 10%). Conclusions. Acute changes of left ventricular afterload and dimensions were clearly indicated by 2D measurements. As M-mode measures were not conclusive for left ventricular dimensional changes, WSM was not an appropriate parameter for acute afterload alterations. WS2D is an afterload index superior to WSM that cannot be estimated by SVR.
    Notes: Zusammenfassung Bei 21 beatmeten Intensivpatienten wurden akute linksventrikuläre Nachlaständerungen unter Noradrenalin oder Nitroglyzerin mittels der transösophagealen Echokardiographie (TEE) überwacht. Mit der TEE wurde die linksventrikuläre endsystolische Myokardspannung (endsystolischer „wall stress``, WS) im zweidimensionalen Verfahren (2D) und im M-mode-Verfahren (M) bestimmt und diese beiden Nachlastparameter mit dem systemischen Gefäßwiderstand (SVR) verglichen. Änderungen der linksventrikulären Nachlast wurden von allen drei Kenngrößen in der Richtung übereinstimmend erfaßt, in Relation zur WS 2D jedoch durch die WS M und den SVR um 15–30% geringer eingeschätzt. WS 2D , WS M und SVR korrelierten untereinander nicht. Der berechnete geometrische Faktor der WS 2D reflektierte die Größenveränderung des linken Ventrikels unter der Behandlung sowohl mit Noradrenalin als auch mit Nitroglyzerin, der geometrische Faktor der WS M dagegen nicht. Aus den Ergebnissen ist zu schließen, daß die WS 2D ein besserer Parameter für die Abschätzung akuter linksventrikulärer Nachlaständerungen ist als die WS M . Die Abschätzung der linksventrikulären endsystolischen Myokardspannung mit dem SVR ist nicht möglich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050137
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  • 5
    Electronic Resource
    Electronic Resource
    Erste klinische Erfahrungen mit der transnasalen ösophagealen Echokardiographie (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 111-115 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Monitoring ; Echokardiographie ; transösophageale Echokardiographie ; Herz ; Ventrikel ; Endokard ; Meßtechniken ; akustische Quantifizierung ; Key words Monitoring ; echocardiography ; transesophageal ; transnasal ; Heart ; ventricle ; endocardium ; Measurement techniques ; acoustic quantification
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Currently undergoing a clinical trial a new miniaturized monoplane ultrasound probe potentially enhances the practicability of perioperative transesophageal echocardiography (TEE) without loss of echocardiographic quality. Methods: In the present prospective study, the nasally inserted miniaturized TEE probe was tested in 12 ventilated patients and compared with a conventional TEE probe. Echocardiographic quality was tested by two independent investigators by analyzing the percentage of the endocardium contour detection (〈50%, 50–75%, 75–100%) in the left ventricular short- and long-axis views. Results: In 11 patients, more than 50% of endocardium were visualized continuously with both probes. Although the nasal TEE probe was inferior to conventional TEE in detecting lateral endocardium, automated endocardium detection compared well with both methods. Inter- and intraobserver variability in manual measurements of the left ventricular cross-sectional area was below 5% on average and differed non-significantly with regard to the method. In 2 patients, continuous monitoring was aggravated by repeated loss of contact between the miniaturized TEE probe and mucosa. Conclusions: In comparison with conventional TEE, the miniaturized TEE probe provides practicability advantages without significant loss of information for cardiovascular monitoring.
    Notes: Zusammenfassung Eine derzeit in klinischer Erprobung befindliche neue miniaturisierte monoplane Ultraschallsonde kann die Praktikabilität der perioperativen transösophagealen Echokardiographie (TEE) möglicherweise erhöhen, ohne daß dies auf Kosten der echokardiographischen Qualität geht. Methodik: In der vorliegenden prospektiven Untersuchung wurde die nasal eingeführte miniaturisierte TEE-Sonde bei 12 intubierten, beatmeten Patienten geprüft und mit einer konventionellen TEE-Sonde verglichen. Die Qualität der echokardiographischen Bildsequenzen wurde von zwei unabhängigen Untersuchern anhand des Umfangs der Endokard-Konturerkennung (〈50%, 50–75%, 75–100%) im linksventrikulären Kurz- und Längsachsenblick analysiert. Ergebnisse: Bei 11 Patienten ließen sich mehr als 50% des Endokards mit beiden Sonden kontinuierlich darstellen. Obwohl die nasale TEE der konventionellen TEE im lateralen Endokardbereich unterlag, war die automatische Endokarddetektion bei beiden Methoden gleich gut. Die Inter- und Intraobservervariabilitäten der manuellen Vermessung linksventrikulärer Querschnittsflächen lagen im Mittel unter 5% und wiesen hinsichtlich des Verfahrens keine signifikanten Unterschiede auf. Bei 2 Patienten war die kontinuierliche TEE-Überwachung wegen wiederholter Kontaktabrisse des miniaturisierten TEE-Schallkopfs von der Schleimhaut erschwert. Schlußfolgerungen: Die miniaturisierte TEE-Sonde bietet im Vergleich zur konventionellen TEE praktische Vorteile ohne wesentlichen Informationsverlust für die kardiovaskuläre Überwachung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050535
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  • 6
    Electronic Resource
    Electronic Resource
    Einflussfaktoren von Übelkeit und Erbrechen nach Narkosen Fiktionen und Fakten (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 629-642 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter PONV ; Postoperative Übelkeit ; Erbrechen ; Einflussfaktoren ; Fiktionen ; Fakten ; Key wordsReview ; Postoperative nausea and vomiting ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Numerous factors have been claimed to influence postoperative nausea and vomiting (PONV). A critical review of the literatur reveals, that strong evidence based on original double-blind, randomized, controlled trials or their meta-analyses is only available for very few risk factors. For most other factors, although mentioned in narrative reviews, there is insufficient evidence. Sufficient evidence on original data or meta-analyses is present for female gender, a history of PONV or motion sickness, non-smoking-status, young age, volatile anaesthetics, nitrous oxide and postoperative opioids. Factors with conflicting results are the menstrual cycle, hypnotics for induction, mask ventilation and nasogastric tube, the experience of the anaesthetist, muscle relaxants and their antagonists and laparoscopic procedures. Insufficient evidence is present for the other types of operation, psychological factors including anxiety and pain. No evidence due to lack of data applies to postoperative movement, hemodynamic stability, hypercarbia and acid-base-shifts. For adipositas there is not only a lack of evidence for an effect but evidence for a lack of effect based on several multivariate analyses. In conclusion, we have developed the following simplified view: PONV is mainly caused by opioids and volatile anaesthetics when applied to susceptible patients (females, non-smoker, positive history of previous sickness).
    Notes: Zusammenfassung In der Vergangenheit wurde eine Vielzahl von Risikofaktoren für Übelkeit und Erbrechen (Ü& E) nach Narkosen angeführt. Bei kritischer Durchsicht der Literatur fällt jedoch auf, dass nur wenige Faktoren durch Fakten hinreichend belegt sind, während der Einfluss der meisten in Übersichtsarbeiten angeführten Faktoren fraglich ist. Durch Daten belegte Risikofaktoren sind weibliches Geschlecht, eine positive Anamnese von Ü& E, der Nichtraucherstatus, junges Alter, volatile Anästhetika, Lachgas und postoperative Opioide. Faktoren mit kontroverser Datenlage sind der Menstruationszyklus, die Einleitungshypnotika, die Maskenbeatmung und die Magensonde, die Erfahrung des Anästhesisten, Muskelrelaxanzien und deren Antagonisierung sowie laparoskopische Eingriffe. Nicht ausreichend belegte Risikofaktoren sind alle anderen Operationen, psychologische Faktoren, Schmerz und Hypoxie. Nicht belegte Faktoren sind postoperative Bewegungsreize, hämodynamische Stabilität, Hyperkapnie und Entgleisungen des Säure-Basen-Haushalts. Ein durch Daten eindeutig widerlegter Risikofaktor ist die Adipositas. Daher läßt sich ein vereinfachtes Modell ableiten: Ü&E nach Narkosen werden hauptsächlich durch Inhalationsanästhetika und Opioide bei prädisponierten Patienten (Frauen, Nichtraucher und positive Anamnese) hervorgerufen (Abb. 1).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070080
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  • 7
    Electronic Resource
    Electronic Resource
    Prävention der pulmonalen Aspiration von Mageninhalt mit einer neuen Ballonmagensonde (1994)
    Springer
    Der Anaesthesist 43 (1994), S. 16-25 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Aspiration – Narkose – Prophylaxe – Magensonde – Ballon – Kardia ; Key words: Aspiration – Anaesthesia – Prevention – Nasogastric tube – Balloon – Cardia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. The rapid sequence induction of anaesthesia in patients with an increased risk of pulmonary aspiration is a quite involved procedure associated with many potential dangers. A new nasogastric balloon tube has been developed, which will prevent the reflux of gastric contents by blocking the cardia with a balloon. It was the aim of this initial study to assess the efficiency of the tube in animals, healthy volunteers and patients. Methods. With the approval of the Animal Ethics Committee, a total of 16 anaesthetised pigs were used for the animal experiments. Balloon occlusion of the cardia was performed in 10 pigs. Six further pigs with an unblocked cardia served as controls. Vomiting and regurgitation was provoked in each animal using six different manoeuvres while the gastro-oesophageal (lower oesophageal) sphincter and intragastric pressures were monitored and the lower oesophagus was continuously inspected using an endoscope. With local Ethics Committee approval and informed written consent, (1) repeated vomiting was provoked in 16 awake, healthy adult volunteers (10 females, 6 males, 29±4 years) with a fluid-filled stomach in the presence and in the absence of balloon occlusion of the cardia, while intragastric pressure was monitored, and (2) 30 patients (21 – 89 years) with an increased risk of pulmonary aspiration scheduled for abdominal or traumatologic surgery received conventional induction of anesthesia after blocking of the cardia with the balloon. Results. Pigs (n=10) with a blocked cardia showed no gastrooesophageal reflux during a total of 60 manipulations to provoke vomiting and regurgitation, while 28 of the 36 provoking manipulations induced reflux in pigs (n=6) with an unblocked cardia. Among the healthy volunteers with a blocked cardia (n=16), reflux of gastric contents was not observed during repeated attempts to stimulate vomiting. After termination of the occlusion of the cardia, reflux was able to be induced by 14 of the 16 volunteers. In 30 patients with an increased risk of pulmonary aspiration the cardia was blocked and anaesthesia was induced using a mask and manual ventilation without encountering any problems. The average time from loss of consciousness to tracheal intubation was 164±8 s. Conclusions. It is concluded from the present results, with further clinical studies pending, that the gastric balloon probe permits low-risk conventional induction sequence of anaesthesia in patients with an increased risk for pulmonary aspiration and that the device may also be safely used during the extubation phase.
    Notes: Zusammenfassung. Die Narkoseeinleitung bei aspirationsgefährdeten Patienten ist aufwendig und mit Gefahren und Risiken für den Patienten verbunden. Im Tierexperiment, Probandenversuch und im klinischen Test wurde die Funktionstüchtigkeit einer neuen Ballonmagensonde geprüft, die den Reflux von Mageninhalt durch Blockung der Kardia verhindern soll. 1.) 10 Schweine mit Kardiablockung zeigten unter insgesamt 60 Maßnahmen zur Provokation von Erbrechen und Regurgitation keinen gastro-ösophagealen Reflux, während bei 6 Schweinen mit ungeblockter Kardia 28 von insgesamt 36 Provokationsmanövern zu einem Reflux führten. 2.) Bei 16 Probanden mit geblockter Kardia wurde unter Emesisprovokation kein Reflux von Mageninhalt beobachtet. Nach Aufhebung der Kardiablockung konnte bei 14 der 16 Probanden ein Reflux ausgelöst werden. 3.) Bei 30 aspirationsgefährdeten Patienten mit Ballonmagensonde konnte eine Narkoseeinleitung mit Maskenbeatmung problemlos durchgeführt werden. – Vorbehaltlich weiterer klinischer Prüfergebnisse wird gefolgert, daß die Ballonmagensonde ohne großen Aufwand eine risikoarme Narkoseeinleitung und Intubation bei aspirationsgefährdeten Patienten ermöglicht und auch bei der Ausleitung der Narkose einsetzbar ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00013233
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  • 8
    Electronic Resource
    Electronic Resource
    Ist ein Score zur Voraussage von Erbrechen auch auf Pelviskopien anwendbar? Anmerkungen zu einem Beitrag in Der Anaesthesist (1999) 48:705–712 (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 227-229 
    Details
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050820
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  • 9
    Electronic Resource
    Electronic Resource
    Fulminant malignant hyperthermia associated with ketoacidotic diabetic coma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 809-812 
    Details
    ISSN: 1432-1238
    Keywords: Malignant hyperthermia ; Halothane ; Caffeine ; Diabetes ; Stress ; Cresol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Malignant hyperthermia (MH) in humans is usually triggered by volatile anaesthetics and depolarizing muscle relaxants. However, other factors or drugs (e.g. cresol) are thought to induce MH. We report a case of fulminant MH associated with a ketoacidotic diabetic coma. After therapy for diabetic coma with insulin (containing the preservative cresol) and electrolyte solutions was started, the patient complained of increasing myalgia, developed a high fever and respiratory and metabolic acidosis and lost consciousness. MH was treated immediately with dantrolene; the patient recovered within 14 days. Five months later the patient was diagnosed as MH-susceptible by the in vitro caffeine and halothane contracture test. This case supports the assessment that MH and diabetes are associated diseases and that cresol could possibly trigger MH. Furthermore, therapy with dantrolene has been demonstrated to the beneficial in the treatment of MH associated with diabetic coma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709525
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  • 10
    Electronic Resource
    Electronic Resource
    Fulminant malignant hyperthermia associated with ketoacidotic diabetic coma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 809-812 
    Details
    ISSN: 1432-1238
    Keywords: Key words Malignant hyperthermia ; Halothane ; Caffeine ; Diabetes ; Stress ; Cresol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Malignant hyperthermia (MH) in humans is usually triggered by volatile anaesthetics and depolarizing muscle relaxants. However, other factors or drugs (e.g. cresol) are thought to induce MH. We report a case of fulminant MH associated with a ketoacidotic diabetic coma. After therapy for diabetic coma with insulin (containing the preservative cresol) and electrolyte solutions was started, the patient complained of increasing myalgia, developed a high fever and respiratory and metabolic acidosis and lost consciousness. MH was treated immediately with dantrolene; the patient recovered within 14 days. Five months later the patient was diagnosed as MH-susceptible by the in vitro caffeine and halothane contracture test. This case supports the assessment that MH and diabetes are associated diseases and that cresol could possibly trigger MH. Furthermore, therapy with dantrolene has been demonstrated to be beneficial in the treatment of MH associated with diabetic coma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709525
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