[Hemodynamic-kinetic controlled extracorporeal circulation in heart surgery].

Mimicking the physiological characteristics of the circulatory system, pulsatile bloodflow has also been introduced into extracorporeal perfusion to avoid known postoperative complications. In a mathematical consideration of the situation bloodflow is seen as a function of time F(t) for approximately constant vessel diameter over a given time. The kinetic energy of a column of blood produced by the heart-lung machine is transmitted directly to the arterial circulation via the aorta.

Elimination of drugs by the new polyamide hemofilter FH77H during various in vitro conditions.

Background/aims: Multiple organ failure alters the dosage of drugs during hemofiltration. To separate factors, we utilized in vitro hemofiltration to investigate different blood flows, protein concentrations and intracellular drug partition with the FH77H polyamide membrane.

Methods: One liter of warm heparinized fresh human blood was hemofiltrated in two series: (1) with digoxin, netilmycin, phenobarbital, ceftriaxone and teicoplanin, and (2) with amikacin, theophylline, ceftazidim, phenytoin and vancomycin and, in addition, with cell-free fresh frozen plasma.

Pharmacokinetics of ceftriaxone in patients undergoing continuous veno-venous hemofiltration.

Continuous hemofiltration is used widely in the management of patients with acute renal failure, but administration guidelines for many drugs have yet to be established. In this study, the pharmacokinetics of ceftriaxone were compared in patients with normal renal function (n = 9), mild renal insufficiency (n = 5), and acute renal failure receiving continuous veno-venous hemofiltration (n = 6). Pharmacokinetic parameters were determined under steady state conditions.

Drug administration in critically ill patients with acute renal failure.

Patients with acute renal failure are commonly treated by continuous renal replacement therapies. To understand drug disposition in multiple organ failure patients, the pharmacokinetics of 18 drugs were evaluated in 243 patients. Continuous hemofiltration served as a model for constant elimination rates.

[Anesthesia with propofol during an exacerbated course of acute intermittent porphyria].

In the eighth week of pregnancy the medical indication for induced abortion was established due to an exacerbating acute intermittent porphyria with life-threatening neurological symptoms. delta-aminolaevulinic acid and porphobilinogen were excessively increased in urine prior to the operation. Anaesthesia was induced with a bolus of propofol, alfentanil and droperidol, maintained by 67% of nitrous oxide and small bolus injections of the three drugs.

Pharmacokinetics and dosage adjustment of antibiotics during continuous extracorporeal lung assistance and hemofiltration.

Fifty-eight patients undergoing continuous volume-controlled hemofiltration (CVHF) and extracorporeal lung assistance (ECLA) received drug therapy determined by use of a new predictive algorithm in a validation study. Amikacin, netilmicin, tobramycin, ceftriaxone, vancomycin, and teicoplanin doses were given as predicted from clinical parameters. Corrections were necessary in 15 cases (e.

Evaluation and first validation study on a simplified drug dosage algorithm for multiple organ failure patients.

As reported previously, drug concentrations during continuous hemofiltration (HF) and extracorporeal lung assist (ELA) follow certain rules, which can be expressed by a simplified algorithm for dosage adjustment: Drug sieving (S, fu) depends on the protein free fraction with small limitations, while the extrarenal elimination rate is not a constant but correlates inversely with the clinical state, r = -0.34, p = 0.00067, n = 96.

[Infection-induced change in the pharmacokinetics of cefotaxime. Dose calculation in multiple organ failure and relevance of score systems].

The pharmacokinetics of cefotaxime were investigated in 14 patients suffering from multiple-organ failure requiring pump-assisted, continuous volume-constant hemofiltration (CVHF) for blood purification, whereby the filtration rate was 20 ml/min. Samples of blood and ultrafiltrate were evaluated by high-pressure liquid chromatography. For dose adjustment, three different algorithms of Dettli and Kroh were used.

[Drugs in the intensive care unit--need for dosage adjustment in organ failure].

Drug dosage in intensive care patients is a common problem that cannot be sufficiently solved in practice. To obtain an idea as to the variance of multiorgan failure during treatment, the pharmacokinetics of 17 drugs were evaluated in 96 patients. Continuous hemofiltration served as a model for constant elimination rates.

[Dosage adjustment of drugs during continuous hemofiltration. Results and practical consequences of a prospective clinical study].

In 43 ICU patients undergoing continuous volume constant hemofiltration (CVHF), the pharmacokinetics of 12 drugs were investigated to ensure correct dosage adjustments. Under conditions of CVHF, maximum doses were defined for cefotaxime, ceftazidime, digoxin, digitoxin, imipenem, metronidazole++, netilmicin, phenobarbital, phenytoin, theophylline, tobramycin, and vancomycin. For the estimation of sufficient doses without blood level measurements, sieving coefficients (S) were calculated by a new method.

[Bilateral pneumothorax following laparoscopy].

A case of laparoscopy is presented with postoperative large subcutaneous emphysema and bilateral pneumothorax. As a result of careful control, conservative treatment, and consequent oxygen administration, this life-threatening phenomena disappeared within a short time. Preventive measures for complications of diagnostic laparoscopy are discussed and established to lower the anaesthetic risk of this widely practised procedure.

[Peridural anesthesia and analgesia results in general surgery].

Anesthesia for major general surgery should involve the use of anesthetic techniques that might reduce the risk of intraoperative and postoperative complications. The combination of intraoperative epidural anesthesia with local anesthetics (EPA) and the use of epidural opiates for postoperative pain relief shows advantages over the application of pure general anesthesia and over postoperative systemic analgesia. Epidural opiates lead to better quality analgesia with a quicker onset and longer duration than systemical analgesics.

Time saving protein binding assay for the simultaneous determination of guanosine 3':5'-monophosphate (cGMP) and adenosine 3':5'-monophosphate (cAMP) in human urine.

A time-saving protein binding assay for the simultaneous determination of cGMP and cAMP has been adapted for human urine, using [3H]cGMP, [14C]cAMP, protein fractions from calf skeletal and lobster tail muscles and the phosphodiesterase inhibitor SQ 20.009. Recovery, accuracy, and precision are approximately at the 10% limit.