Blood lactate and pyruvate levels in the perioperative period of liver resection with Pringle maneuver.

Introduction: Bleeding during liver surgery is often routinely controlled by the Pringle maneuver consisting in the temporary clamping of hepatic artery, portal vein, and bile duct. This study aimed at investigating a possible influence of the Pringle maneuver on tissue hypoxia during liver resection.

Methods: Twenty-five consecutive patients undergoing elective liver resection were prospectively randomized either to be treated with the Pringle maneuver (Pringle group, n = 14) or without clamping (Controls, n = 11).

[Intratracheal foreign body caused by a sheared endotracheal intubation stylet].

After orotracheal intubation of a 30-year-old man with a flexible tube, a floating foreign body was noticed inside the tube. The subsequent bronchoscopy revealed a second foreign body near the bifurcation of the trachea. Both foreign bodies were removed successfully and identified as parts of the plastic-sheathed stylet.

Effects of clonidine and superficial cervical plexus block on hemodynamic stability after carotid endarterectomy.

Objectives: To evaluate the effects of 2 interventions (intravenous clonidine and superficial cervical block) on hemodynamic stability after carotid endarterectomy and to identify variables associated with hemodynamic instability.

Design: Prospective, observational study, sequential enrollment.

Setting: University hospital.

The unanticipated difficult intubation: rigid or flexible endoscope?

Background: Unanticipated difficult intubation occurs with a frequency between 1.5% and 8.5%.

[Anaesthesiological management in orthotopic liver transplantation -- results of a survey].

Objective: Since there is no therapeutical standard for the anaesthesiological approach during liver transplantation (LTX) in Germany at the moment, we have evaluated the current anaesthesiological procedures during LTX.

Methods: All departments of anaesthesiology (n = 24) cooperating with transplantation centers in Germany received a questionnaire via mail regarding following complexes: anaesthesiological methods, anaesthetics, blood components therapy, perioperative monitoring, supportive cardiovascular therapy and staff.

Results: The answers (n = 16) showed following results: Balanced anaesthesia with continuous application of opioids was the standard method (80 %).

Movement of the upper cervical spine during laryngoscopy: a comparison of the Bonfils intubation fibrescope and the Macintosh laryngoscope.

The movements of the upper cervical spine were measured by fluoroscopy in 20 patients during laryngoscopy with the Bonfils intubation fibrescope and the Macintosh laryngoscope. Laryngoscopy with both the Bonfils intubation fibrescope and the Macintosh laryngoscope resulted in significant extension of the cervical spine as compared to the neutral position but this extension was significantly less with the Bonfils intubation fibrescope than with the Macintosh (p = 0.001).

[Catecholamine levels in plasma and cerebrospinal fluid of neurosurgical patients with normal and elevated intracranial pressure].

Objective: Catecholamine levels in the plasma and cerebrospinal fluid of 21 neurosurgical patients with hydrocephalus and with normal and elevated intracranial pressure were determined prospectively in a clinical study.

Methods: The study comprised 11 patients with normal intracranial pressure (8 female, 3 male, group 1) and 10 patients with elevated intracranial pressure (6 female, 4 male, group 2). The patients underwent a ventriculo-peritoneal shunt operation, external ventricular drainage or ventriculocisternostomy.

[Anaesthesia for combined pancreatic and renal transplantation in a patient with mitochondrial encepahalomyopathy--a case report].

Mitochondrial disorders encompass a group of syndromes produced by genetic defects that disrupt mitochondrial energy production. The impaired mitochondrial energy supply affects nearly all organs and tissues leading to a variable clinical presentation. The possible multisystem involvement complicates the management of anaesthesia and perioperative care.

[The influence of normobaric hyperoxia on hepatic oxygenation--experience with an animal model].

We investigated the effect of a ventilation with an FiO2 of 1.0 on arterial and hepatic venous oxygenation in 23 Göttingen minipigs. Under balanced anaesthesia (isoflurane/fentanyl), a fibreoptic catheter was placed into a hepatic vein.

Assessment of hepatic ischemia-reperfusion injury by simultaneous measurement of tissue pO2, pCO2, and pH.

Introduction: The objective of this study was to determine whether the simultaneous measurement of tissue pH, pCO(2), and pO(2) with a multiple-parameter fiberoptic sensor (Paratrend 7) can be used for continuous monitoring of hepatic microperfusion in a pig model of hepatic ischemia given endothelin(A) receptor antagonist (ET(A)-RA) or isotonic saline.

Methods: Fourteen anesthetized swine were subjected to 2 h of hepatic vascular exclusion. The animals were randomized into two groups: control group (n = 7, saline solution iv) and therapy group (n = 7, ET(A)-RA).

[Is fiber optic hepatovenous oximetry useful in patients undergoing elective partial liver resection?].

The validity of continuous measurement of hepatic venous oxygen saturation using a fibreoptic technique was investigated and set in correlation with intermittent measurements of saturation in hepatic venous blood in patients undergoing elective partial liver resection (pLR). Eleven patients (4 m/7 f, average age: 62.6 +/- 11.

[Is the combination of remifentanil and propopfol suitable for transsphenoid resection of the hypophysis?].

In a multi-center trial, the feasibility of combining remifentanil (RF) and target-controlled infusion of propofol (P) for patients undergoing transsphenoidal resection of the pituitary gland was tested. After IRB approval, 74 patients (29 male/45 female) were included in the study. The concentration of RF and the target concentration of P were recorded as were heart rate (HR) and mean arterial blood pressure (MAP).

[Comparative studies of patient positioning for lumbar intervertebral disk operation].

For surgery on lumbar disks by the posterior route, patients are placed either on a Wilson frame or in genupectoral position. The aim of the prospective study was to record and describe the haemodynamic changes resulting from the patients' position. After written informed consent had been received, 80 neurosurgical patients undergoing lumbar disk surgery were randomly divided into two groups; group I--Wilson frame, group II--genupectoral position.

[Hyperoxia-induced liberation of big-endothelin into jugular venous blood of electric neurosurgical patients].

The use of hyperoxia in emergency situations is generally accepted, but the routine and uncritical application of higher oxygen concentrations is criticized. The influence of short-term application of hyperoxia on cerebral oxygenation, cerebral lactate and BIG-endothelin (BIG-ET) was studied. After approval by the Ethics Committee of the University of Leipzig, 22 patients (hyperoxia group n = 16, normoxia, control group n = 6) undergoing an elective craniotomy were included in the study.

Gross-total surgery of supratentorial low-grade gliomas under intraoperative MR guidance.

Background And Purpose: Length of survival of patients with low-grade glioma correlates with the extent of tumor resection. These tumors, however, are difficult to distinguish intraoperatively from normal brain tissue, often leading to incomplete resection. Our goal was to evaluate the effectiveness of intraoperative MR guidance in achieving gross-total resection.

[Is the combination of nitrous oxide and hyperventilation in elective neurosurgical operations useful?].

The use of nitrous oxide (N2O) and hyperventilation (HV) in elective neurosurgery is controversially discussed. The emphasis of the study was to show the effects of N2O and/or moderate hyperventilation (paCO2 31.0 +/- 1.

[Effect of normobaric hyperoxia on parameters of brain metabolism].

In the literature there is only little information about the influence of hyperoxia on cerebral metabolic parameters. The aim of our study was to examine the effect of increased inspiratory oxygen concentrations on parameters of brain metabolism in elective neurosurgical patients. Ten patients undergoing an elective craniotomy for brain tumour resection were included in the study.

[Use of the sitting position in neurosurgery. Results of a 1998 survey in Germany].

Objectives: This 1998 survey was carried out on the use of the sitting position for neurosurgical procedures in the posterior fossa and operations of the craniospinal and cervical spine region by the dorsal approach. In addition, anesthetic management of the sitting position and the compliance with recommendations of the Neuroanesthesia Study Group of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) published in 1995 were investigated and compared to results of a 1995 survey.

Methods: A questionnaire was sent to 152 departments of anesthesiology in Germany providing anesthesia for neurosurgical procedures.

[Effect of local anesthetics on hemodynamic effects during Mayfield skull clamp fixation in neurosurgery using total intravenous anesthesia].

For neurosurgical procedures, the association between insertion of the Mayfield skull clamp and haemodynamic changes is generally recognized. We investigated the protective effect of two local anaesthetic substances (lidocaine and bupivacaine) under the conditions of total intravenous anaesthesia (TIVA) with propofol and alfentanil. Forty-two patients undergoing an elective craniotomy (tumor resection) were included in the study and randomly divided into three groups.

N2O-induced hypoxia as a model of hypoxic stress of rat myocardium. An ultrastructural-morphometric study.

A model system consisting of a hypoxia chamber combined with a commercial narcosis apparatus adapted to small animals was used to perform a controlled acute isobaric hypoxia on rats with N2O/O2. Ultrathin sections from the left ventricular wall were analysed qualitatively and quantitatively using a computer-aided morphometric program. Compared with the control the cardiomyocytes exhibited a significant increase of volume densities of cytoplasmic vacuoles, lipid drops, sarcoplasmic reticulum, mitochondria, and degenerated intramitochondrial areas.

The effect of different ventilation regimes on jugular venous oxygen saturation in elective neurosurgical patients.

Since the concept of hyperventilation on neurosurgical and neurotraumatological patients has been contested, our analysis was aimed at its scrutiny on the basis of easily accessible parameters of perisurgical monitoring. Furthermore, the influence of an improved oxygen supply was tested on hyperventilationally induced cerebral changes and to what extent recommendations could be derived for clinical application. In 50 patients (normoventilation FiO2 = 0.

[The sitting position in neurosurgical operations. Results of a survey].

Methods: In February 1995 a questionnaire was sent out on perioperative management during neurosurgical operations performed in the sitting position to 136 centres and hospitals within the Federal Republic of Germany that perform neuroanaesthesia. The response rate was 61.02%.

Hypoxia-dependent changes of enzyme activities in different fibre types of rat soleus and extensor digitorum longus muscles. A cytophotometrical study.

Using cytophotometry activity changes of succinate dehydrogenase, glycerol-3-phosphate dehydrogenase and myofibrillar adenosine triphosphatase were measured in 3 fibre types of soleus and extensor digitorum longus muscles under normal and experimental conditions. Fibres were typed by means of cytophotometrical data into slow-oxidative, fast-oxidative glycolytic and fast-glycolytic ones. After experimental hypoxia of 20 min duration a significant increase of enzyme activities was observed especially in slow-oxidative and fast-oxidative glycolytic fibres of both muscles, e.