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Biomedical subjects

A Doenicke

Publications and source records attributed to A Doenicke.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Processes of perioperative risk from the viewpoint of the anesthesiologist].

Nearly all of the pharmaceutical preparations that are used for anesthesia can release histamine. H1 and H2 receptor blockades are recommended for the following groups of patients at risk: 1) Patients who show hypersensitivity to i.v. administered medications and radiological contrast media. 2) Patients with risk factors in their case histories, e.g., atopy, previous cardiac and/or pulmonary damage, and an age of over 70 years. 3) Conditions with a pathological increase in the plasma histamine level. Such conditions include (a) polytrauma, chronic kidney insufficiency, patients under radium irradiation treatment; (b) the exploration phase during a surgical procedure, more frequent blood transfusions, extracorporeal circulation, and Palacos implantation. 4) Chymopapain for chemonucleolysis.

Anaphylaxis↗
PubMed1987

Influence of the histaminergic system on opiate-induced neurosecretion and behaviour.

The influence of the histaminergic system on fentanyl (Fe)-induced growth hormone (GH) and prolactin (PRL) release as well as on Fe-induced increase of noradrenaline (NA) plasma levels has been studied in male volunteers. These volunteers received, according to a randomized block design, different pretreatments: the H1-antagonist dimethindene (Di) (0.1 mg/kg i.v.), or the H2-antagonist cimetidine (Ci)(5 mg/kg i.v.), or a combination of dimethindene and cimetidine (Di + Ci), or saline. The PRL increase caused by Fe (0.2 mg/70 kg) was not altered by pretreatment with the H1-antagonist Di, the H2-antagonist Ci, or the combination of both. The increase of NA plasma levels after Fe also was not modified by the histamine antagonists. In contrast, the maximum GH increase after Fe was blunted by the combination of Ci and Di, but not by either Ci or Di alone. These results suggest an involvement of the histaminergic system in opiate-induced GH-release.

Adult↗
PubMed1986

Changes in noradrenaline plasma levels and behavioural responses induced by benzodiazepine agonists with the benzodiazepine antagonist Ro 15-1788.

Noradrenaline (NA) plasma levels were examined in 18 healthy volunteers on 2 consecutive days after a single treatment with either lormetazepam (0.06 mg/kg) (LMZ group), flunitrazepam (0.03 mg/kg) (FNZ group) or placebo (PLA group) in combination with the benzodiazepine (BZ) antagonist Ro 15-1788 (0.1 mg/kg). Behavioural responses (mood changes, anxiety) were also investigated in parallel. Both BZ decreased NA plasma levels to 50% of the basal values 10 min after the injection; administration of Ro 15-1788 15 min later reinstated NA plasma levels to basal values. A second administration of Ro 15-1788 (0.1 mg/kg) 24 h after BZ or PLA treatment increased NA plasma levels, estimated 10 min after the injection in both the LMZ- and the FNZ groups, but not in the PLA group. Behavioural responses measured under the same treatment also indicated minor anxiety responses followed by mood impairment. These data suggest that a stressful situation may be precipitated by the antagonist Ro 15-1788 24 h after a single BZ treatment, which resembles a withdrawal response, and increases NA plasma levels.

Adult↗
PubMed1986

[Propofol in comparison with etomidate for the induction of anesthesia].

In the present study propofol and etomidate were compared with respect to the effects on the cardiovascular system and its side effects in 100 patients ASA grade I-IV. Anaesthesia was induced with 2.2 mg kg-1 body weight propofol. Supplemented with opioids and benzodiazepins the dose diminished to 1.8 mg kg-1 body weight (18.2%). In comparison with etomidate after propofol decrease in blood pressure was more marked, especially when supplemented with opioids and benzodiazepins but without supplementation these values ranged within acceptable limits. Following intubation blood pressure and heart rate after propofol increased only to the base line values contrary to etomidate. Following propofol administration smooth induction with very good ventilation was remarkable. Myocloni and anaphylactoid reactions were not seen. Pain on injection was frequent but thrombosis and phlebitis were not observed. There was a considerably lower incidence of postoperative nausea and vomiting compared with etomidate. The investigators concluded: propofol can be recommended for induction of anaesthesia as an alternative to etomidate.

Adult↗
PubMed1986

[Effect of homeopathic drugs on the phagocytic activity of human granulocytes. In vitro tests in a controlled single-blind study].

Four homeopathic drug preparations with extract dilutions between D1 and D30 (expression for the homeopathic grade of potencies) and some additives (minerals and animal toxins) were investigated, using two in vitro and one in vivo phagocytosis models. All preparations enhanced significantly the activity of phagocytosis in all used systems. In controlled prospective single-blind studies with the preparations C and D performed on 12 and 14 verum and 13 male placebo volunteers respectively with i.v. injections within a 5-day treatment the phagocytosis indices were measured during 11 days using the microscopic smear method. In both investigations the maximum of phagocytosis activity was reached between the 4th and 5th day of injection. After the 4th or 5th (next to the last or last) injection, a rapid decrease of activity occurred which reached normal values on the 11th day. Other laboratory parameters investigated were not influenced.

Adult↗
PubMed1985

[Histamine liberation induced by anesthetics or their solvents: specific or non-specific?].

Histamine release is a frequent event in the perioperative period. The reasons for its occurrence are complex; they include pseudoallergic and allergic phenomena--and probably a mixture of both. Some drugs and solvents seem to modulate histamine release induced by other drugs. Thus the terms "specific and nonspecific" or "selective and nonselective" histamine release which have their well appreciated place in experimental immunology and pharmacology should be avoided in describing histamine release responses in clinical conditions. The clinical relevance of histamine release in the perioperative period is considerable and can be compared with that of perioperative thrombosis and thromboembolism. Far too many drugs and anaesthetic and surgical procedures give increased plasma histamine levels; premedication with H1- + H2-histamine receptor antagonists is therefore recommended in patients who have a history of hypersensitivity reactions to intravenous agents; a history of atopy, who are to be given the same drug a few days later, undergo surgery with a high risk of histamine release, are more than 70 years old or are poor risk patients with perioperative cardiac, respiratory or liver failure and shock.

Anesthetics↗
PubMed1985

Flunitrazepam and lormetazepam do not affect the pharmacokinetics of the benzodiazepine antagonist Ro 15-1788.

Following a single intravenous dose of 0.1 mg/kg, the pharmacokinetics of Ro 15-1788, a specific benzodiazepine antagonist, have been investigated in 20 healthy male volunteers. In random order injection of Ro 15-1788 has been preceded (5 min) by intravenous dosing with 0.06 mg/kg of lormetazepam (n = 6), 0.03 mg/kg of flunitrazepam (n = 8) or placebo (n = 6). The rapid elimination of the antagonist could be characterized by an elimination half-life between 0.9 to 1.4 h and a total plasma clearance of 727 to 1440 ml/min. These single dose studies indicate that the disposition of Ro 15-1788 was not affected by the acute coadministration of both benzodiazepines.

Adolescent↗
PubMed1985

H1 and H2 blockade: a prophylactic principle in anesthesia and surgery against histamine-release responses of any degree of severity: Part 1.

In the perioperative period, histamine release was shown in numerous situations and pathological states. They include diseases or complications of diseases, preparation and premedication of patients, induction of anaesthesia, maintenance of anaesthesia and surgery, and administration of drugs and treatment in the immediate postoperative period. A premedication with histamine H1 and H2 receptor antagonists was developed which in five controlled clinical trials blocked histamine-release responses of all grades of severity. These included single spots of erythema or a wheal up to life-threatening reactions or even death of the patient or laboratory animal. The necessity for a new premedication was investigated by methods of medical decision-making considering the incidence of the reactions, classification of severity, efficiency of prophylaxis and treatment of anaphylactoid reactions, and side-effects. As a result, the premedication with dimethpyrindene (Forhistal, Fenistil) plus cimetidine (Tagamet) was recommended in a series of patients at risk: those with a history of hypersensitivity reactions to intravenous agents or atopy, patients with a second I.V. drug exposure within a few days, those undergoing surgery with a high risk of histamine release, patients of greater than 70 years age, and poor-risk patients with preoperative cardiac, respiratory or liver insufficiency and shock.

Anaphylaxis↗
PubMed1985

Effects of propofol ('Diprivan') on histamine release, immunoglobulin levels and activation of complement in healthy volunteers.

This randomized study compared the effects of the emulsion formulation of propofol with those of the Cremophor-containing agent Althesin. Plasma histamine concentration, immunoglobulin levels, total complement C3 and complement C3 conversion were measured prior to and following induction of anaesthesia in 32 male volunteers with either 2 mg/kg propofol or 0.05 ml/kg Althesin. In only one volunteer, in the Althesin group, was an increase in plasma histamine to a value greater than 1 ng/ml associated with a relatively large increase over the base line value. Cutaneous signs, such as flushing, did not correlate with the plasma concentrations of histamine. No changes consistent with a propensity to produce anaphylactoid reactions could be seen from measurements of immunoglobulin levels, complement C3 or plasma histamine concentration in the propofol treated subjects.

Adolescent↗
PubMed1984

Modern trends in the investigation of new hypnotics in anaesthesia.

Over the last 20 years standardized techniques have been employed for the investigation of intravenous hypnotics, psychotropic and neuroleptic drugs. Sleep has been studied with the help of EEG measures and side-effects have been evaluated by psychometric tests. The EEG is a proven parameter with regard to dosage determination and as objective means to find sleep-inducing quantities of drugs. By means of vigilosomnograms we have established dose-effect curves and have made comparisons between related drugs in the form of equivalence studies. From an anaesthesiological point of view controllability of a substance is determined by duration of effect (short- or long-acting) and by depth of sleep (light or deep states) achieved. By these criteria midazolam displays good controllability with regard to duration, but not in terms of depth of sleep, since it follows the "all-or-nothing" rule, even with 0.1 mg/kg following both intravenous or intramuscular injection. Lormetazepam, on the other hand, shows good controllability of depth of sleep from tranquillity via sedation to hypnosis, but duration of effect is less well controllable in that patients remain lightly asleep even after 2 h. According to the vigilosomnograms the lormetazepam/oxygen/nitrous oxide combination produced a super-added increase in the depth of the hypnotic effect. After droperidol the specific nitrous oxide component of the depth of sleep at Bo stage was not exceeded. The development of benzodiazepine antagonists, which immediately counteract the benzodiazepine induced sleep and respiratory obstruction is a milestone in the area of CNS research.

Anesthesia↗
PubMed1984

Dose-dependent influence of fentanyl on prolactin, growth hormone, and mood.

The effect of Fentanyl (FE), an opioid agonist, on neurosecretion and mood was investigated in normal volunteers using doses of 0.1, 0.2, 0.25 mg/70 kg. FE caused a strong dose-dependent increase in prolactin (PRL) secretion in every subject. In contrast, growth hormone (GH) was stimulated significantly at the highest dose only. Additionally, FE induced a significant increase in feeling of wellbeing measured by the Visual Analogue Scale (VAS).

Adult↗
PubMed1984

[Effect of etomidate and thiopental on ACTH and cortisol levels in serum. A prospective controlled comparative study in healthy probands].

A prospective controlled trial was carried out to determine the influence of etomidate and thiopentone on serum levels of cortisol and plasma levels of adrenocorticotrophic hormone (ACTH). There were two groups of nine healthy male volunteers: one group was given 0.3 mg/kg body wt. etomidate and the other 4 mg/kg body wt. thiopentone intravenously as a bolus. The hormone levels were measured before and every 30 min after injection of the anaesthetic over a period of 5 h. After thiopentone, cortisol levels dropped from a mean value of 13.2 micrograms/dl to a minimum of 9.0 micrograms/dl after 90 min and fluctuated between 9.2 and 10.9 micrograms/dl until the end of the experiment. Etomidate induced a more pronounced decrease in cortisol levels (from the 90th min the differences to the levels after thiopentone were statistically significant) from 13.9 micrograms/dl to a minimum of 5.0 micrograms/dl after 150 min. After 300 min cortisol levels had recovered only to 7.7 micrograms/dl. Plasma levels of ACTH were also different in the two groups. After thiopentone they decreased from 26.1 pg/ml to 18.2 pg/ml after 30 min, then increased to 30 pg/ml after 300 min. After etomidate, ACTH levels were as high at 30 min as before the injection and increased continuously to 67.1 pg/ml by the end of the experiment; from the 150th min on, the differences to the ACTH levels after thiopentone were statistically significant. We conclude from these hormone levels that a single intravenous bolus injection of thiopentone induces a slight but statistically significant and ACTH-independent decrease in adrenal cortisol secretion in healthy volunteers not stressed by an operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗