Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • subarachnoid haemorrhage  (3)
  • Cervical spondylosis  (1)
  • Continuous infusion  (1)
  • 1
    ISSN: 0942-0940
    Keywords: Ruptured cerebral aneurysms ; subarachnoid haemorrhage ; early operation ; delayed ischaemic deficit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A prospective open multicenter study on the preventive effect of nimodipine on symptomatic vascular spasm was performed in 120 (consecutive) patients with aneurysmal subarachnoid haemorrhage (SAH). All patients underwent early surgery (i.e. within 72 hours post SAH) and were in neurological grades I–III in Hunt and Hess. Grade IV and V as well as patients with significant intracerebral haematoma are not included. On preoperative CT, SAH was mild in 28 cases, moderate in 56 and severe in 36 cases. 25 patients (21%) were in grade I, 63 patients (53%) in grade II and 32 patients (26%) in grade III. The ruptured aneurysm was located on the anterior cerebral artery complex in 57 patients, on the internal carotid artery complex in 35, on the middle cerebral artery in 24 patients and on the basilar artery in 4 patients. After occlusion of the ruptured aneurysm, the lipophilic calcium channel blocker nimodipine was administered in the following manner: 1. Intraoperative, topical irrigation of the exposed arteries. 2. Intravenous infusion until day 7–14 after SAH followed by peroral medication for another week. Nimodipine was well tolerated and neither significant hypotension nor any other adverse reaction attributable to the drug was observed. Ischaemic cerebral dysfunction of delayed onset with permanent neurological deficit occurred in 2 patients (2%). Another 8 patients showed transient ischaemic symptoms. At 6 months follow-up, 93 % of the patients were classified as having made a full recovery, 16% as being minimally disabled, 5% as being moderately disabled and 3% as being severely disabled. Three patients had died. The present study supports the concept that preventive nimodipine treatment may reduce delayed ischaemic deficit in early aneurysm surgery.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 0942-0940
    Keywords: Cerebrospinal fluid ; eicosanoids ; prostaglandins ; subarachnoid haemorrhage ; thromboxane
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary CSF eicosanoid levels are raised following subarachnoid haemorrhage but not sufficiently to be vasoactive per se within the cerebral circulation. Rebleeding and intraventricular haemorrhage are two factors associated with a worse outcome after aneurysmal SAH. We have examined the effects of these two factors on the CSF levels of TXB2 (TXA2 metabolite), PG 6-keto F1α (prostacyclin metabolite), PGF2α and PGE2 in 44 patients following subarachnoid haemorrhage. In 15 patients who had received no non-steroidal antiinflammatory agent or dexamethasone, intraventricular haemorrhage increased the median levels of all four eicosanoids in ventricular CSF by 2.1–5.1-fold. In 4 patients who rebled, the CSF median levels of all four eicosanoids were raised up to 250-fold over the normal range. These concentrations are just sufficient to have cerebrovascular and neuromodulatory effects.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    ISSN: 1432-1041
    Keywords: nimodipine ; subarachnoid haemorrhage ; pharmacokinetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Patients with a ruptured supratentorial aneurysm undergoing early surgery after the subarachnoid haemorrhage were treated postoperatively with nimodipine to prevent delayed ischaemic dysfunction. It was given first as a continuous intravenous infusion 2 mg/h (mean dose 0.5 µg/kg/min) for at least 7 days, and then orally (45 mg × 6) for at least a further 7 days. During the i.v. infusion, the mean plasma concentration was 26.6±1.8 ng/ml. The plasma clearance ranged from 0.57 to 1.77 l/kg/h and was negatively correlated with the age of the patient. Immediately prior to successive oral doses, the mean plasma concentration was 13.2 ng/ml (range〈3–38.8 ng/ml). The peak level was usually found after 1 h; it ranged from 7.0–96.0 ng/ml. Mean bioavailability was 15.9%. The nitropyridine metabolite was found in measurable concentrations only after oral treatment with nimodipine. In some cases, the concentration of metabolite exceeded that of the parent compound. The three patients investigated who developed delayed ischaemic dysfunction had plasma concentrations well within the range in patients who did not, so it seems unlikely that the therapeutic failure could be attributed to individual deviations in the pharmacokinetics of the drug.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Spritzenpumpen ; hydrostatischer Druck ; Katecholamine ; Vasodilatatoren ; Komplikationen ; Key words Cardiovascular drugs ; Syringe pumps ; Continuous infusion ; Mishaps ; Hydrostatic pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Administration of highly concentrated, highly potent, and therefore highly dangerous drugs with syringe pumps is common in modern anaesthesia as well as in intensive care and emergency medicine. Because of their exact flow rates down to 〈1 ml/h, these pumps are predestined for delivery of drugs with short half-lives, such as catecholamines and vasodilators. But intravenous application of drugs with syringe pumps is not without problems. While it is well known that syringes not fixed correctly into the pump can empty themselves by the influence of gravity, it seems not to be known that hydrostatic pressure can influence the flow rate of a correctly connected system even during continuous infusion. In this situation a change of height of the syringe pump in relation to the patient's position can have tremedous effects on hemodynamics due to unintended acceleration or deceleration of the flow rate. This case report demonstrates that the elevation of a connected epinephrine pump while moving a cardiac surgery patient after ACB operation from the operation table into his bed led to critical increases of heart rate, blood pressure and left atrial pressure. In order to quantify the problem we repeated the situation experimentally. It could be demonstrated that the elevation of the syringe pump by 80-100 cm delivers an additional bolus of 4–5 drops as the central venous catheter outlet. Lowering the pump consecutively leads to the opposite effect. In the case reported, the accidentally administered bolus of epinephrine was 12–15 μg (we use a concentration of 60 μg/ml epinephrine for continuous infusion with syringe pumps). From this accidental observation the following conclusion can be drawn: The change of height, in relation to the patient's position, of a running syringe pump during continuous infusion of highly concentrated cardiovascular drugs may cause considerable, even life-threatening hemodynamic disorders. Even in a closed infusion system (syringe-extension-central venous catheter), hydrostatic pressure influences infusion rate. Elevation of the pump leads to unintended bolus administration, and lowering of the pump is followed by an interruption of the infusion. In the knowledge of this phenomenon, unexpected hemodynamic reactions during transport of critically ill patients cannot always be interpreted as a result of inadequate anesthesia or volume load, but may be a consequence of incorrect handling of the syringe pumps as described in this report.
    Notes: Zusammenfassung Auf der Basis einer Fallbeobachtung wird der Einfluß des hydrostatischen Drucks auf die Kontinuität der Applikationsgeschwindigkeit in einem geschlossenen Spritzenpumpensystem dargestellt. Bei Umlagerung eines kardiochirurgischen Patienten nach Operationsende vom Operationstisch in das Intensivbett wurde deutlich, daß die in dieser Zeitspanne häufig zu beobachtenden Herzfrequenz- und Blutdruckänderungen nicht unbedingt durch eine inadäquate Narkosetiefe oder durch den Umlagerungsvorgang des Patienten selbst verursacht sind, sondern durch das Anheben der laufenden, mit Katecholaminen oder Vasodilatatoren bestückten Spritzenpumpen. Durch die Änderung der Höhendifferenz zwischen Patient und angeschlossener Pumpe – im geschilderten Fall wurde die Pumpenhöhe im Vergleich zum Patienten um +80 bis 100 cm verändert – erhöhte sich der hydrostatische Druck im Infusionssystem, der Patient erhielt unbeabsichtigt und unkontrolliert einen Bolus Adrenalin, der anschließend in einer experimentellen Überprüfung des Phänomens als eine Menge von 12–15 μg quantifiziert werden konnte. Zur Vermeidung ungewollter Kreislaufreaktionen beim Umlagern oder während des Transports kritisch kranker Patienten, die auf die kontinuierliche Zufuhr hochkonzentrierter, kreislaufwirksamer Substanzen angewiesen sind, ist unbedingt darauf zu achten, daß auch bei konnektiertem System und laufender Infusion die relative Höhe der Spritzenpumpen zum Patienten nicht abrupt verändert wird. Durch unbeabsichtigte Bolusgaben (Anheben der Spritzenpumpen) oder kurzzeitige Unterbrechung der kontinuierlichen Infusion (Absenken der Spritzenpumpen) können z.T. schwerwiegende Kreislaufreaktionen induziert werden.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    ISSN: 0942-0940
    Keywords: Cervical spondylosis ; cervical disc ; Cloward procedure ; anterior fusion ; late myelography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary During a 13 year period, 286 patients with cervical disc herniation and/or spondylotic spurs, were subjected to anterior decompression and vertebral interbody fusion with autologous bone. Twenty patients were re-admitted in the late postoperative period due to recurrent radicular symptoms and/or signs of myelopathy. In these patients myelography was performed again. In 14 patients spinal cord compression and/or nerve root involvement at a new level was visualized. At the operated level, however, the myelograms demonstrated a smooth anterior wall in the spinal canal. The series confirms the safety, effectiveness and reliability of the Cloward procedure in achieving long term spinal cord and nerve root decompression, and a solid vertebral interbody fusion.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...