[DGAI-certified seminar series: anaesthesia focussed echocardiography: module 4 cardiosonography].

The use of ultrasonography in perioperative medicine has developed rapidly within the last decade. Today ultrasonic techniques are established methods for peripheral and central venous access as well as for regional anaesthesia. However, transthoracic ultrasonography by non-cardiologists has not yet been routinely established perioperatively, in intensive care medicine or in emergency medicine.

A comparison of transoesophageal echocardiographic Doppler across the aortic valve and the thermodilution technique for estimating cardiac output.

This study was undertaken in order to elucidate the differences between various planes of measurement and Doppler techniques (pulsed- vs. continuous-wave Doppler) across the aortic valve to estimate cardiac output. In 45 coronary artery bypass patients, cardiac output was measured each time using four different Doppler techniques (transverse and longitudinal plane, pulsed- and continuous-wave Doppler) and compared with the thermodilution technique.

High thoracic epidural anesthesia, but not clonidine, attenuates the perioperative stress response via sympatholysis and reduces the release of troponin T in patients undergoing coronary artery bypass grafting.

Unlabelled: In this prospective study, we evaluated whether high thoracic epidural anesthesia (TEA) or i.v. clonidine, in addition to general anesthesia, affects the cardiopulmonary bypass- and surgery-associated stress response and incidence of myocardial ischemia by their sympatholytic properties.

Combining nonpharmacologic therapies for advanced heart failure: the Münster experience with the assist device-defibrillator combination.

Implantable cardioverter defibrillators (ICDs) and ventricular assist devices (VADs) have been used as a bridge to cardiac transplantation. In selected patients, the combined implantation may be required. This study was motivated by a case of a 33-year-old female patient with giant cell myocarditis who died of ventricular tachyarrhythmias after having been placed on a VAD with which she had been treated on an out-of-hospital basis for a prolonged period of time.

Milrinone modulates endotoxemia, systemic inflammation, and subsequent acute phase response after cardiopulmonary bypass (CPB).

Background: Compromised splanchnic perfusion and the resulting intestinal mucosal injury leads to a decreased mucosal barrier function, which allows translocation of intestinal flora and endotoxemia. The authors evaluated the effects of milrinone on splanchnic oxygenation, systemic inflammation, and the subsequent acute-phase response in patients undergoing coronary artery bypass grafting.

Methods: This open, placebo-controlled randomized clinical study enrolled 22 adult patients in two groups.

Assessment of cardiovascular volume status by transoesophageal echocardiography and dye dilution during cardiac surgery.

Conventional evaluation of cardiovascular volume status by filling pressures is unreliable in critically ill patients. Measurements of left ventricular end diastolic area index by transoesophageal echocardiography and of intrathoracic blood volume index by dye indicator dilution are new approaches to this problem. In this study, different indices of cardiovascular volume status were analysed to define their relation during the pronounced haemodynamic changes associated with systemic inflammation after cardiopulmonary bypass.

Emergency versus elective/urgent left ventricular assist device implantation.

Background: The risk and outcome in patients undergoing left ventricular assist device (LVAD) implantation on an emergency basis is still unclear.

Methods: Since April 1993, 40 patients received a Novacor and 8 patients a Heartmate LVAD in our institution. Patients with emergency LVAD placement were compared with the remainder in a retrospective manner.

Thoracoscopic interruption of patent ductus arteriosus compromises cardiopulmonary function in newborn pigs.

Unlabelled: Interruption of patent ductus arteriosus (PDA) using video-assisted thoracoscopic surgery (VATS) has recently been introduced into clinical practice. To study cardiovascular and pulmonary function during VATS, we treated 16 newborn pigs (weight 1421+/-44 g) with PDA with conventional surgical interruption (CSI; n = 7) or interruption via VATS (n = 9). Measurements of hemodynamics and gas exchange were performed before, during, and after surgery.

Neonatal mechanical bridging to total orthotopic heart transplantation.

Background: Until recently, newborns with medically intractable cardiac failure caused by congenital malformations were mostly doomed to death because of the severity of the disease, which precludes a palliative operation, or because of fatal deterioration before availability of a suitable donor heart.

Methods: The recently developed paracorporeal pneumatically driven Medos HIA ventricular assist device offers a therapeutic option for these small infants because it is manufactured in various sizes and is even suitable for cardiac assistance in neonates with a body surface area less than 0.3 m2.

[Anesthesia for minimal invasive coronary surgery without employing extracorporeal circulation].

In the course of present reevaluation of aortocoronary bypass grafting a minimal invasive surgical procedure avoiding the use of cardiopulmonary bypass has been revised. It is suitable born for palliative treatment of patients with coronary multi-vessel-disease and compromised left ventricular function, and likewise for curative treatment of patients with single-vessel disease of a left coronary artery branch and unimpaired ventricular function. Avoiding possible complications of cardiopulmonary bypass can minimise morbidity and lethality of aortocoronary bypass grafting procedure and can help to lower costs.

Impact of perioperative transesophageal echocardiography on cardiac surgery.

Transesophageal echocardiography (TEE) is recognized as a semi-invasive technique with increasing impact on diagnostic tools in cardiac surgery. Particularly, TEE plays a role in patients undergoing cardiac valve repair or congenital heart surgery with regard to the assessment of the operative success. Other proven roles of TEE are in evaluating atheromatous disease of the aortic arch, detection of aortic dissection and aneurysm, and diagnosis of pathologic findings within the heart and the pericardial sac.

Cardiac pacemaker infection: surgical management with and without extracorporeal circulation.

Background: Pacemaker infections are rare, but serious complications of pacemaker therapy. The generator pocket, the pacing leads, or both may be involved.

Methods: We report on 12 patients with infected pacemaker systems.

Increased plasma concentrations of serum amyloid A: an indicator of the acute-phase response after cardiopulmonary bypass.

Objectives: To assess the expression of mixed and hepatic venous serum amyloid A (SAA) concentrations and its relationship to plasma concentrations of C-reactive protein, interleukin-6 (IL-6), and endotoxin during and after cardiopulmonary bypass (CPB).

Design: Prospective, consecutive sample with repeated measurements.

Setting: Surgical intensive care unit (ICU) in a university hospital.

[Transesophageal echocardiography in anesthesia and intensive care. The diagnostic importance of transesophageal echocardiography].

Transoesophageal echocardiography (TEE) is recognised as a semi-invasive technique that has an increasing impact as a diagnostic tool in anaesthesia and intensive care medicine. However, adequate assessment of TEE is based on knowledge of basic echocardiographic principles and their limitations and sufficient educational training of the user. TEE has an established role in various clinical circumstances.

The effect of general anaesthesia on breathing patterns in elderly patients during the early post-operative period.

This study was designed to investigate the incidence of critical events in breathing following light general anesthesia compared with normal sleep during the first 12 h after transfer from the recovery room. There were no significant differences in the incidence of apnoea or desaturation episodes between normal sleep and the post-operative recovery period. There was a close correlation between the pre-operative and post-operative incidence of apnoea (r = 0.

Effects of dopexamine on creatinine clearance, systemic inflammation, and splanchnic oxygenation in patients undergoing coronary artery bypass grafting.

Impairment of splanchnic and peripheral tissue perfusion during cardiopulmonary bypass (CPB) may be responsible for endotoxin-mediated systemic inflammation and acute phase responses. We examined the effects of dopexamine on hemodynamic parameters, creatinine clearance, systemic and splanchnic oxygenation, gastric mucosal pH (pHi), and mixed and hepatic venous plasma levels of endotoxin, interleukin-6 (IL-6), serum amyloid A (SAA), and C-reactive protein (CRP) in 44 patients scheduled for coronary artery bypass grafting. Patients were randomized to receive continuous infusions of 0.

Influence of enoximone on systemic and splanchnic oxygen utilization and endotoxin release following cardiopulmonary bypass.

Objective: We investigated whether the administration of enoximone during and after cardiopulmonary bypass (CPB) improves splanchnic oxygen utilization and thereby gut mucosal integrity in humans by its vasodilating and inotropic properties.

Setting: Surgical intensive care unit (ICU) in a university hospital.

Design/patients: 21 patients (ASA III classification) scheduled for elective coronary artery bypass grafting were enrolled in the study.

Effects of enflurane and isoflurane on splanchnic oxygenation in humans.

Study Objectives: To determine the effects of enflurane and isoflurane on hepatic venous oxygen saturation (ShvO2) and splanchnic oxygen (O2) extraction. To measure hemodynamic parameters and ShvO2, mixed venous, and arterial lactate concentrations during enflurane and isoflurane anesthesia.

Design: Randomized, prospective study.

Effects of positive end-expiratory pressure ventilation on splanchnic oxygenation in humans.

Objectives: To examine the influence of positive end-expiratory pressure (PEEP) ventilation on splanchnic oxygenation and lactate production in humans without pulmonary disorders.

Design: Prospective study.

Setting: Single-institutional surgical intensive care unit in a university hospital.

Smoke inhalation causes a delayed increase in airway blood flow to primarily uninjured lung areas.

Objective: Single lung inhalation injury causes tissue damage to the contralateral lung. We therefore examined airway blood flow after smoke inhalation in chronic instrumented sheep to get further information about the underlying pathophysiology.

Design/patients: The right lung and lower trachea of 5 animals were smoke-exposed, while their left lung was air-insufflated using a split ventilation technique.

[Hemo- and cardiodynamic effect of nifedipine in halothane or isoflurane anesthesia. An animal experiment study].

Objective: The present experimental study on 16 acutely instrumented dogs was designed to determine the haemo- and cardiodynamic changes after an intravenous infusion of nifedipine during halothane or isoflurane anaesthesia.

Methods: General anaesthesia was induced with ketamine (10 mg/kg) and fentanyl (0.02 mg/kg) and maintained with fentanyl (0.

Plasma copper and iron changes in sheep after left lung inhalation injury: effect of the thromboxane antagonist BM 13.177 (Solutroban).

A significant decline in plasma concentrations of copper and iron were observed in sheep exposed to preferential smoke inhalation of the left lung. The decline was evident 30 minutes after smoke inhalation, and the levels of both trace metals persisted at quite low levels for up to the 18-hour time interval after injury. From that time a gradual recover for copper but not for iron levels was observed so that by 24 hours the levels of copper were in the same range of those at baseline.