Walter Plöchl

Walter Plöchl
Medical University of Vienna | MedUni Vienna · Klinische Abteilung für Allgemeine Anästhesie und Intensivmedizin

Professor of Anesthesiology and Intensive Care, MD

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54
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Publications

Publications (54)
Article
Full-text available
Background Pregabalin is commonly used perioperatively to reduce post-operative pain and opioid consumption and to prevent the development of chronic pain. It has been shown to reduce anesthetic consumption in balanced anesthesia, but studies investigating its effect on the minimum alveolar concentration (MAC) of volatile anesthetics are lacking. T...
Article
Full-text available
A high number of trauma patients are under the influence of alcohol. Since many of them need immediate surgical procedures, it is imperative to be aware of the interaction of alcohol with general anesthesia. To counter challenges that arise from clinical studies, we designed an animal experiment in which 48 adult Wistar rats either received 1 g · k...
Article
Background Obese patients are at risk for rapid oxygen desaturation during anesthesia induction. Apneic oxygenation with regular flow oxygen insufflation has successfully been used to prolong the duration of safe apnea without desaturation (DAWD) in morbidly obese patients. Using high-flown nasal insufflation of oxygen (HFNI) for apneic oxygenation...
Article
Background: Cannabis has increasingly been used for medical and recreational purposes. The main pharmacological compound in cannabis is tetrahydrocannabinol (THC), which has sedative, anxiolytic and analgesic effects. In some animal models, THC has also been shown to reduce the minimum alveolar concentration (MAC) of halothane and cyclopropane, bu...
Article
Background Ketamine is routinely used in operating theatres, emergency departments, ICUs, and even outpatient units. Despite the widespread use of ketamine, only basic aspects of its interactions with inhalation anaesthetic agents are known, and formal testing of interactions in humans is lacking. The minimum alveolar concentration (MAC) of inhalat...
Article
Background: Sevoflurane is a volatile anesthetic commonly used to maintain anesthesia in patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT). Growing evidence suggests that patients with ESLD have decreased anesthetic requirements compared to patients with preserved liver function. The potency of volatile...
Article
Experimental studies suggest that macrophage migration inhibitory factor (MIF) mediates ischemia/reperfusion injury during liver transplantation. This study assessed whether human liver grafts release MIF during preservation, and whether the release of MIF is proportional to the extent of hepatocellular injury. Additionally, the association between...
Article
Full-text available
Background: The isolated forearm technique is used to monitor intraoperative awareness. However, this technique cannot be applied to patients who must be kept deeply paralysed for >1h, because the tourniquet preventing the neuromuscular blocking agent from paralysing the forearm must be deflated from time to time. To overcome this problem, we test...
Article
The anaesthetic potency of intravenous propofol is quantified by its Cp50 value, which is defined as the plasma concentration required to prevent movement response in 50% of patients to surgical stimuli. We hypothesised that, in addition to propofol anaesthesia, an intravenous bolus of lidocaine 1.5 mg/kg will decrease the Cp50 value of propofol du...
Article
Full-text available
Background: The anesthetic effect of volatile anesthetics can be quantified by the minimum alveolar concentration (MAC) of the drug that prevents movement in response to a noxious stimulus in 50% of patients. The underlying mechanism regarding how immobilization is achieved by volatile anesthetics is not thoroughly understood, but several drugs af...
Article
The Internet has become the largest, most up-to-date source for medical information. Besides enhancing patients' knowledge, the freely accessible audio-visual files have an impact on medical education. However little is known about their characteristics. In this manuscript the quality of lumbar puncture (LP) and spinal anaesthesia (SA) videos avail...
Chapter
Anästhesie kommt aus dem Griechischen und bedeutet „ohne Empfi ndung“; Narkose kommt ebenfalls aus dem Griechischen und bedeutet „in Schlaf versetzten“. Die Anästhesie entstand aus der Notwendigkeit, chirurgische Eingriff e durch Ausschaltung der dabei entstehenden Schmerzen zu ermöglichen. In Ägypten und Griechenland wurde bereits lange vor Christ...
Article
The aim of this cohort study was to assess the cumulative effect of marginal donor criteria on initial graft function and patient survival after liver transplantation. We included 734 consecutive patients who underwent orthotopic liver transplantation at the Vienna General Hospital between January 1993 and December 2003. We employed the local regis...
Article
Levosimendan, a novel calcium sensitizer, enhances cardiac contractility by increasing myocyte sensitivity to calcium, and induces vasodilation. In this prospective observational study the haemodynamic effects of levosimendan in postoperative critically ill patients are reported. Twelve patients with the need for inotropic support were studied. One...
Article
Full-text available
To investigate the relationship between changes in core and skin surface temperature and extubation time in patients following normothermic cardiopulmonary bypass (CPB). Prospective observational study. Intensive care unit (ICU) of a university hospital. Patients admitted to the ICU after cardiac surgery. None. Thirty-two patients undergoing cardia...
Article
Hemodynamic alterations are a well-known phenomenon that influence the outcome of orthotopic liver transplantation (OLT). Whether or not myocardial dysfunction, which has various causes, contributes to this instability is still debated. Previous transesophageal echocardiography (TEE) studies have presented controversial data, not leading to final c...
Article
Acute colonic pseudo-obstruction (Ogilvie’s syndrome) is a clinical entity characterized by massive nontoxic dilatation of the colon in the absence of mechanical obstruction and is associated with increased morbidity and mortality in the immunosuppressed patient. We present a case of a kidney transplant recipient developing a life-threatening condi...
Article
Full-text available
Asymptomatic carotid artery stenosis (CAS) may result in neurological injury after coronary artery bypass surgery, but routine preoperative carotid screening is not undisputed. We studied whether routinely determined carotid duplex results, beyond detecting high-risk patients, additionally influence intraoperative course. One hundred and eight pati...
Article
Cerebral embolization is a major cause of central nervous dysfunction after cardiopulmonary bypass. Experimental studies demonstrate that reductions in arterial carbon dioxide tension (PaCO2) can reduce cerebral embolization during cardiopulmonary bypass. This study examined the effects of brief PaCO2 manipulations on cerebral embolization in patie...
Article
There is a growing number of inborn errors of metabolism (IEM) with late onset but nevertheless life threatening course. Patients: Patients with late onset variants of urea cycle defects, fatty acid oxidation defects and organic acidurias are demonstrated. Methods: Biochemical, enzymatic, molecular methods and especially tandem mass spectrometry (T...
Article
Ornithine transcarbamylase (OTC) deficiency, the most common inherited urea cycle disorder, shows a spectrum of severity ranging from severe neonatal hyperammonemic coma to no symptoms among adults. We report on the multiorgan procurement from a donor who died of cerebral edema due to unrecognized late-onset OTC deficiency. The donor's OTC deficien...
Article
Abstract Ornithine transcarbamylase (OTC) deficiency, the most common inherited urea cycle disorder, shows a spectrum of severity ranging from severe neonatal hyperammonemic coma to no symptoms among adults. We report on the multiorgan procurement from a donor who died of cerebral edema due to unrecognized late-onset OTC deficiency. The donor's OTC...
Article
We report on late-onset ornithine transcarbamylase (OTC) deficiency in two families with mutations in the same codon, but different base substitutions. Onset of symptoms showed great variation, and five hemizygotes finally died. Clinical diagnosis was late and difficult. In family A, 1 patient also developed the signs of Gilbert's disease. In famil...
Article
To determine the thresholds of selective shunting in carotid endarterectomy during general anesthesia, we compared transcranial Doppler ultrasonography and cerebral oximetry (RSO2). During carotid cross-clamping, RSO2 and mean blood flow velocity in the middle cerebral artery (Vm,mca) was simultaneously monitored in 55 of 59 patients. A relative de...
Article
Impaired pulmonary function is a frequent finding in patients undergoing orthotopic liver transplantation (OLT). Experimental data suggest an essential contribution of splanchnic ischemia and reperfusion as a result of intraoperative volume shifts, i.e., the accumulation of extravascular lung water (EVLW). Increases of intrathoracic blood volume (I...
Article
Full-text available
We have evaluated the intra- and postoperative analgesic efficacy of preservative-free S(+)-ketamine compared with bupivacaine for caudal block in paediatric hernia repair. After induction of general anaesthesia, 49 children undergoing hernia repair were given a caudal injection (0.75 ml kg-1) of S(+)-ketamine 0.5 mg kg-1 (group K1), S(+)-ketamine...
Article
Patients experience cerebral embolization during cardiopulmonary bypass (CPB). This study determined if alterations in temperature and/or PaCO2 can reduce cerebral and ocular embolization. Forty-four pigs underwent CPB: 24 animals at 28 degrees C, and 20 at 38 degrees C. The two temperature groups were randomized to undergo embolization (67-microm...
Article
Full-text available
We have developed a new technique of combined high-frequency jet ventilation (HFJV), characterized by simultaneous application of a low-frequency (LF) and a high-frequency (HF) jet stream. Tubeless supralaryngeal jet ventilation was delivered via a modified Kleinsasser laryngoscope. We studied 44 adults undergoing 45 elective surgical procedures of...
Article
Cerebral embolization is a primary cause of cardiac surgical neurologic morbidity. During cardiopulmonary bypass (CPB), there are well-defined periods of embolic risk. In theory, cerebral embolization might be reduced by an increase in pump flow during these periods. The purpose of this study was to determine the CPB flow-embolization relation in a...
Article
To the Editor: Ornithine transcarbamylase deficiency is the most common inherited disorder of the urea cycle.1,2 It is an X-linked disease that can range in severity from hyperammonemic coma in neonates to the absence of symptoms in adults.1,2 Liver transplantation is an effective treatment for patients with this disease.3 However, this disease has...
Article
To examine the effects of phenylephrine infusion and increases in pump flow on systemic oxygen supply and demand when they are used to support mean arterial pressure (MAP) during cardiopulmonary bypass (CPB). Prospective, unblinded study. The animal cardiopulmonary laboratory at the Mayo Foundation (Rochester, MN). Twelve pigs. Twelve pigs had syst...
Article
Tonometry is a clinically accepted method to monitor blood flow of the splanchnic region, which is of particular interest in orthotopic liver transplantation (OLT). We investigated the hemodynamic changes and the tonometrically registered perioperative course of the difference between gastric mucosal pCO2 (prCO2) and arterial mucosal CO2 (CO2 gap)...
Article
Full-text available
To test the hypothesis whether in patients undergoing liver transplantation the antioxidant tirilazad mesylate can reduce hepatic ischaemia-reperfusion injury and improve postoperative outcome. Prospective, randomised, placebo controlled trial. University hospital. 20 patients were randomised to receive either tirilazad mesylate or placebo (saline)...
Article
Full-text available
During cardiopulmonary bypass, haemodilution is standard practice and is accompanied by increases in cerebral blood flow (CBF). We investigated if changes in cerebral vascular resistance (CVR) during cardiopulmonary bypass-haemodilution are dependent on nitric oxide synthase. The cerebral response to haemodilution in nine dogs treated with the nitr...
Article
he onset of cardiopulmonary bypass (CPB) is a period of changing hemodynamics, and during this transition, the position of the aortic and venous cannulas is assessed. Increased arterial line pressures may indicate a malposition of the aortic cannula, whereas reduced venous return to the reservoir of the CPB circuit suggests suboptimal position of a...
Article
Patients undergoing cardiac surgery have a substantial incidence of neurologic complications related to cerebral embolization during cardiopulmonary bypass. The purpose of this study was to determine if adjustments in the arterial carbon dioxide (PaCO2) level can reduce cerebral and ocular embolization. Twenty pigs underwent cardiopulmonary bypass...
Article
Cerebrospinal fluid (CSF) space enlargement has been demonstrated in substance-related disorders like alcohol and cocaine dependence. Experimental animal studies showed a reduction in shape and size of mesolimbic dopaminergic neurons after chronic morphine administration. Other studies indicated a change of neurofilament and glial fibrillary acid p...
Article
The management of blood pressure during cardiopulmonary bypass varies widely. This may be particularly relevant with the trend to warmer bypass temperatures and an older patient population. Therefore, we examined the minimal perfusion pressure that maintains cerebral oxygen delivery during cardiopulmonary bypass at 33 degrees C. Ten dogs were place...
Article
Full-text available
Any surgical intervention is associated with an activation of protein catabolism, the extent of which is dependent on the severity of surgical trauma. There is a paucity of reports on protein catabolism after transplantation of chest organs (lung transplantation (LTX) and heart transplantation (HTX)). The aim of the present study was to quantify an...
Article
The purpose of this study was to determine the minimum hematocrit value that can support whole body oxygen consumption during normothermic cardiopulmonary bypass. The effect of hemodilution on peripheral resistance, whole body oxygen delivery, and oxygen consumption was determined over a range of hematocrit values. Measurements were obtained during...
Article
Full-text available
To determine the relation of malnutrition and underlying diagnosis to the length of stay in the Intensive Care Unit (ICU) and to mortality after lung transplantation (LTX). Retrospective ICU chart review. Cardiothoracic ICU in a University hospital. Fifty-one consecutive patients who suffered from end-stage lung disease from April 1992 to January 1...
Chapter
Die Lungentransplantation (LTX) ist eine immer häufiger angewen-dete Behandlungsmöglichkeit für Patienten mit einer terminalen Lungenerkrankung. Es handelt sich dabei um eine recht inhomogene Patientenpopulation, die auf der einen Seite normal ernährte, oft überernährte Lungenfibrosepatienten, auf der anderen Seite bis zur Kachexie ausgezehrte Emph...
Article
There is a growing number of inborn errors of metabolism (IEM) with late onset but nevertheless life threatening course. Patients with late onset variants of urea cycle defects, fatty acid oxidation defects and organic acidurias are demonstrated. Biochemical, enzymatic, molecular methods and especially tandem mass spectrometry (TMS) are used for di...

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