Effects of a dobutamine-induced increase in splanchnic blood flow on hepatic metabolic activity in patients with septic shock.

Background: Septic shock leads to increased splanchnic blood flow (Qspl) and oxygen consumption (VO2spl). The increased Qspl, however may not match the splanchnic oxygen demand, resulting in hepatic dysfunction. This concept of ongoing tissue hypoxia that can be relieved by increasing splanchnic oxygen delivery (DO2spl), however, was challenged because most of the elevated VO2spl was attributed to increased hepatic glucose production (HGP) resulting from increased substrate delivery.

Effects on haemodynamics and catecholamine release of xenon anaesthesia compared with total i.v. anaesthesia in the pig.

In order to investigate haemodynamic response and catecholamine release during anaesthesia with xenon, we conducted a study on 28 pigs which were allocated randomly to one of four groups: total i.v. anaesthesia with pentobarbitone and buprenorphine, and xenon anaesthesia with inspiratory concentrations of 30%, 50% or 70%, respectively, supplemented with pentobarbitone.

Assessment of perioperative glycerol metabolism by stable isotope tracer technique.

The aim of this study was to investigate metabolic changes during and after abdominal hysterectomy with specific regard to glycerol metabolism. Seven otherwise healthy patients with benign uterine myoma were enrolled in this study. Glycerol turnover and hepatic glucose production were measured before and after the operation by using stable-isotope technique ([1,1,2,3,3-2H5]-glycerol, [6,6-2H2]-glucose).

Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia.

Background: The prevalence of respiratory diseases in smokers and nonsmokers and the incidence of perioperative respiratory events (PREs) were investigated for patients undergoing general anaesthesia. The aim was to quantify well-known problems and to identify possible new associations between smoking and PREs.

Methods: From July 1992 to December 1994, risk factors, demographic data, and PREs were documented by an automatically readable anaesthetic record (ARAR).

Reduced postoperative analgesic demand after inhaled anesthesia in comparison to combined epidural-inhaled anesthesia in patients undergoing abdominal surgery.

We studied the effect of epidural/general combination anesthesia, in comparison to inhaled anesthesia, on postoperative pain and analgesic consumption in patients undergoing upper abdominal surgery. Anesthesia was induced with propofol and maintained with enflurane in 70% N2O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.

[Effectiveness of anesthetic gas scavengers fulfilling EN 740 requirements with reference to equipment leakage and fresh gas flow].

Purpose: During inhalation anaesthesia, contaminations of the working environment be anaesthetic volatiles and nitrous oxide occur. The amount of leaking gases is influenced by leakages of the anaesthetic ventilator, by fresh-gas flows and by the effectivity of the scavenging system. Since 1st January 1996 new ventilators have to be equipped with scavenging devices according to the European standard EN 740.

Shed mediastinal blood in 500 elective cardiac surgery patients: is there enough for retransfusion routinely?

Objective: Since an increased use of several blood salvaging measures has contributed to a reduction in perioperative blood loss and the requirement for banked blood in recent years, the aim of this study was to establish current postoperative drainage losses in order to evaluate whether homologous retransfusion may be a useful measure to reduce autologous transfusion in elective cardiac surgery.

Design/setting: This prospective clinical investigation was performed at a University Intensive Care Unit during the first six hours following cardiac surgery.

Patients: 373 men and 127 women undergoing elective cardiac surgery were investigated.

[Liver urea and glucose production in patients with alcohol-induced cirrhosis].

Objective: To use stable isotopes for the analysis of hepatic metabolic pathways (urea synthesis, glucose production), comparing them in alcoholic and normal liver, in order to obtain specific and quantitative information on metabolic functions of the liver.

Patients And Methods: Urea and glucose production as well as alanine metabolism in the liver were studied by means of stable isotopes in 7 males with alcoholic liver cirrhosis (mean age 46 +/- 4 years; height 173 +/- 5 cm; weight 73 +/- 3 kg) and 7 healthy male volunteers as controls (age 26 +/- 3 years; height 180 +/- 5 cm; weight 75 +/- 6 kg). The plasma concentrations of adrenaline, noradrenaline, insulin, glucagon and amino-acids were also measured.

Visual event-related brain potentials in 4-month-old infants at risk for neurodevelopmental impairments.

The recording of event-related potentials (ERPs) is an electrophysiologic technique that has been used to evaluate the functional maturation of neural pathways responsible for recognition memory systems in infants and children. The purpose of this study was to evaluate ERP correlates of visual recognition memory in 4-month-old infants at risk for later cognitive impairments. We compared ERPs using a test of shape recognition at 4 months of age (adjusted for prematurity) in 16 high-risk, neonatal intensive care unit (NICU) survivors and 16 healthy full-term infants.

[Fatal Yersinia infection after intraoperative transfusion].

A 47-year old man was operated for a malignant tumour of the bladder. During cystectomia packed red cells had to be transfused. Minutes after the rapid transfusion the oxygen saturation dropped.

[Perioperative monitoring of the course of anesthesia, the postanesthesia visit and inquiry of patient satisfaction. A prospective study of parameters in process and outcome quality in anesthesia].

Purpose: This study is an investigation into the results of reporting on incidents during and after anaesthesia, to reveal any possible associations between intra-procedural and final outcome. The study contributes to the quality assurance project of the German Society of Anaesthesiology and Intensive Care (DGAI). We adjusted and tabulated our data for preoperative risk and for different methods of anaesthesia.

[The effect of anesthetic method on enflurane air pollution in non-air conditioned operating rooms].

Unlabelled: Pollution of work areas by volatile anaesthetics and nitrous oxide occurs during general anaesthesia. Short anaesthesia procedures are often carried out in operating theatres that are not equipped with air-conditioning systems. Methods of lowering exposure during short procedures, where mask anaesthesia is the usual procedure, are double masks and the laryngeal mask.

Influence of vaginal versus abdominal hysterectomy on perioperative glucose metabolism.

The aim of this study was to investigate the metabolic effects of abdominal versus vaginal hysterectomy with specific regard to perioperative glucose metabolism. Fourteen patients received either abdominal (AH, n = 7) or vaginal hysterectomy (VH, n = 7). Hepatic glucose production was measured before and 2.

[The effect of a heat and moisture exchanger (HME) on bronchial mucus transport in a closed inhalation anesthesia system].

Unlabelled: The administration of dry anaesthetic gases for ventilation leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification with a heat and moisture exchanger (HME) is suggested for ventilation during anaesthesia, particularly when using semi-open breathing systems. Recommendations concerning the use of a HME in the semi-closed system are controversial.

Aerosolized prostacyclin and inhaled nitric oxide in septic shock--different effects on splanchnic oxygenation?

Objectives: To compare the effects of inhaled nitric oxide and aerosolized prostacyclin (PGI2) on hemodynamics and gas exchange as well as on the indocyanine-green plasma disappearance rate and gastric intramucosal pH in patients with septic shock.

Design: Prospective, randomized, interventional clinical study.

Setting: Intensive care unit in a university hospital.

The effects of ketamine-isomers on neuronal injury and regeneration in rat hippocampal neurons.

There is a difference in the relative anesthetic potency of the isomers of ketamine. Neuroprotective differences may therefore also exist. After an 8-min exposure to 500 microM glutamate or axonal transection, cultured rat hippocampal neurons were maintained untreated or in the presence of ketamine-racemate, S(+)-ketamine, or R(-)-ketamine (10(-4) M, 10(-5) M, 10(-6) M).

Perioperative endotoxemia and bacterial translocation during major abdominal surgery: evidence for the protective effect of endogenous prostacyclin?

Objective: To investigate the potential role of endogenous prostacyclin (PGI2) released after mesenteric traction during major abdominal surgery on perioperative endotoxemia and bacterial translocation.

Design: Prospective, randomized, double-blind clinical study.

Setting: Operating room and surgical intensive care unit in a university hospital.

Large-dose administration of 6% hydroxyethyl starch 200/0.5 total hip arthroplasty: plasma homeostasis, hemostasis, and renal function compared to use of 5% human albumin.

Within a daily dose of 20 mL/kg, medium-molecular hydroxyethyl starch (HES) is a safe and effective colloid for intravascular blood volume replacement. The effect of large doses on coagulation and renal function is unknown. We prospectively studied 41 patients undergoing total hip arthroplasty during the perioperative period.

Effects of epinephrine on glucose metabolism in patients with alcoholic cirrhosis.

The cirrhotic liver has been shown to be resistant to the actions of various glucoregulatory hormones. The objective of this study was to investigate the effects of epinephrine on hepatic glucose metabolism in cirrhotic patients. Thirteen cirrhotic and eight healthy subjects were studied.

The role of ascorbic acid and xylitol in etomidate-induced adrenocortical suppression in humans.

Etomidate-induced suppression of cortisol biosynthesis is a result of a blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazol radical of etomidate. Since the generation of steroids requires reductive and energy rich equivalents, the present study examined whether supplementation with ascorbic acid or xylitol, a major source of NADPH, could attenuate adrenal suppression by etomidate in human subjects by promoting the turnover rate of 11-beta-hydroxylase. During continuous etomidate/alfentanil anaesthesia for pelviscopic surgery 30 female patients received either Ringer's lactate, xylitol (0.

Determination of isotope enrichments of magnesium in microwave-digested biological samples by thermal ionization mass spectrometry using a direct loading technique.

The isotope ratios of magnesium were determined in isotopically normal and 26 Mg-enriched samples of human blood, blood plasma, urine and faeces and bovine muscle. The measurements were made with a magnetic sector, thermal ionization mass spectrometer (TIMS) equipped with a multiple ion collector system for simultaneous detection of the ion currents. The samples were decomposed using microwave digestion with HNO3 and HCI.

Effects of selective phosphodiesterase 3 inhibition in the perfused liver of the rat after endotoxin treatment.

1. This study was designed to investigate the role of rat phosphodiesterase 3 (RPDE3) in regulation of liver metabolism in sepsis. We studied the effects of the phosphodiesterase 3 inhibitor (PDI), enoximone, alone and in combination with regulating factors of hepatic carbohydrate metabolism and bile secretion in the perfused liver of rats treated 4 h earlier with endotoxin.

Liver and brain iron deficiency in newborn infants with bilateral renal agenesis (Potter's syndrome).

Significant changes in fetal iron status potentially occur in pregnancies in which reduced fetal nutrient delivery is severe enough to result in intrauterine growth retardation (IUGR), particularly if chronic fetal hypoxia is also present and increases fetal iron demand for hemoglobin synthesis. Neonates rarely die following IUGR secondary to maternal preeclampsia, but bilateral renal agenesis, which is also characterized by reduced maternal-fetal blood flow, late gestation placental failure, and IUGR, is uniformly fatal. We measured neonatal liver iron concentration, as an assessment of fetal storage iron status, and heart and brain iron concentrations, as assessments of nonheme tissue iron status, in 11 infants who died in the neonatal period of bilateral renal agenesis, and compared them with values for gestational age-matched control infants whose gestation was not complicated by fetal growth retardation or hypoxia.