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Biomedical subjects

E Knoche

Publications and source records attributed to E Knoche.

At least 19 recordsLinked to original sources
PubMed1988

[Quality of buprenorphine and morphine as components of combined anesthesia].

Perioperative effects of buprenorphine during and after combined anesthesia for gynecological laparotomies were compared to those of morphine. In a controlled, randomized study two similar groups of patients received flunitrazepam (0.016 mg/kg) and either buprenorphine (0.008 mg/kg) or morphine (0.333 mg/kg); all patients were ventilated with a N2O/O2-mixture. To maintain adequate anesthesia, additional injections of buprenorphine or morphine and a volatile anesthetic agent (enflurane, less than 1.0 vol.%) were administered as needed. In some patients in both groups the injection of thiopental (1-2 mg/kg) became necessary for induction of anesthesia. Hemodynamic parameters showed a slight but not significant increase during intubation and remained stable intraoperatively (Figs. 1 and 2). The frequencies of additional intraoperative injections of buprenorphine or morphine and modalities of enflurane administration were similar in both groups. Based on an awakeness score, recovery from anesthesia was similar in both groups (Fig. 3). All patients were pain-free for a long period postoperatively (pain score 1-2, duration 6-10 h) (Fig. 4). In both groups respiratory depression could be demonstrated by means of ventilatory CO2 response (Figs. 6 and 7). The respiratory depression was of no clinical importance and seems to have been due to the combination of a long-acting benzodiazepine with an opiate. There were no differences in the occurrence of nausea and vomiting in both groups. Buprenorphine seems to be an alternative to morphine in combined anesthesia.

Acid-Base Equilibrium↗
PubMed1984

[Comparative studies on general anesthesia versus peridural anesthesia in primary cesarean section].

In a prospective interdisciplinary study involving the departments of gynaecology, anaesthetics and paediatrics, the influence on both the mother and neonate of general as opposed to epidural anaesthesia was compared in 47 planned caesarean sections. Neither maternal or foetal risk factors were present in these cases, and the cardiotocogram was always normal before the anaesthetic was applied. Methods. Systolic and diastolic blood pressure were carefully monitored. Under an identical infusion regime the following parameters were estimated in maternal blood: blood gas and acid-base status, blood sugar, lactate, beta-hydroxybutyric acid, ACTH and cortisol. These same parameters were also estimated in cord blood taken at delivery. The Apgar score at 1, 5 and 10 minutes, and a complete paediatric assessment including neurostatus at 15 minutes, 24 hours and 7 days of age were used to assess neonatal status. Some of the women given a general anaesthetic initially had marked increases in blood pressure and pulse, while about a third of the epidural cases showed a blood pressure fall despite positioning in the left lateral position in order to prevent the aorto-caval syndrome. An increase in lactate, ACTH and cortisol was found in both groups up to the time of delivery, when the ACTH level of the general anaesthetic group was significantly higher. Acid-base and PCO2 values were not markedly influenced by either of the techniques used, but the maternal capillary PO2 levels were very much higher in the general anaesthetic group. The neonates born under general anaesthetic had a lower 1 min Apgar score, as a result of the relatively long induction-delivery time, of on average 17 min. The 5 and 10 min Apgar scores and the neurophysiological development of the babies revealed no differences between the two groups.

Adult↗
PubMed1983

[Clinical experimental studies of postoperative infusion analgesia].

30 postoperative patients, who had undergone abdominal gynaecological surgery with standard general anaesthesia were randomly divided into three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramid, or ketamine. The patients rated their pain on a 15 cm pain analogue score. Group I pentazocine: Mean dosage on the day of operation 0.12 mg/kg/h, 0.1 mg/kg/h on the first and only 0.07 mg/kg/h on the second postoperative day. Pentazocine blood levels were on average 50 micrograms/l. Group II piritramid: Mean dosage on the day of operation 0.038 mg/kg/h, 0.024 mg/kg/h on the first and 0.019 mg/kg/h on the second postoperative day. Blood levels of piritramid were not determined because there is no satisfactory assay available. Group III ketamine: mean dosage on the day of operation 0.32 mg/kg/h, 0.28 mg/kg/h on the first and 0.29 mg/kg/h on the second postoperative day. Ketamine blood levels lay between 120 and 180 micrograms/l. The three analgesics did not cause any important haemodynamic or respiratory side effects. Pentazocine and piritramid were the most effective analgesics, ketamine was the least effective with a high incidence of side effects.

Adult↗
PubMed1983

[Intramuscular ketamine analgesia in emergency patients. I. Clinico--pharmacokinetic study].

Effective analgesia under conditions of emergency and disaster is still a problem which can be considered as unsolved. The i.m. administration of ketamine in subanaesthetic doses could be one step forward, particularly in regard to a possible application by paramedical personnel. In order to evaluate this hypothesis, we compared 2 groups of 6 patients each, who received either 0.5 mg/kg or 1 mg/kg ketamine respectively i.m. for p.o. pain relief after tonsillectomies. The analgesic efficacy, the levels of consciousness, the blood pressure values and the ketamine plasma levels demonstrated, that effective analgesia can be obtained within 10 min following either dose. The dosage of 1 mg/kg however was followed by a transient impairment of the levels of consciousness. The pharmacokinetic data may lead to the conclusion that analgesia starts above plasma levels of 100 ng/ml. Important side effects were not be observed in these few cases. A further study, which has almost been completed, will demonstrate whether the same results apply to emergency out-patients suffering from fractures, burns etc.

Emergencies↗
PubMed1983

Clinical experimental studies of postoperative infusion analgesia.

Thirty postoperative patients, after undergoing abdominal hysterectomy and standard general anesthesia, were randomly allocated to three groups and received, in the recovery ward, a continuous infusion of either pentazocine, piritramide, or ketamine. The patients rated their pain on a 15-cm visual analog scale. Patients in group 1 received pentazocine. Mean dosage was 0.12 mg/kg/hr on the day of operation, 0.1 mg/kg/hr on the first postoperative day, and only 0.07 mg/kg/hr on the second postoperative day. Pentazocine blood levels averaged 50 micrograms/L. Patients in group 2 received piritramide. Mean dosage was 0.038 mg/kg/hr on the day of operation, 0.024 mg/kg/hr on the first postoperative day, and 0.019 mg/kg/hr on the second postoperative day. Blood levels of piritramide were not determined because no satisfactory assay is available. Patients in group 3 received ketamine. Mean dosage was 0.32 mg/kg/hr on the day of operation, 0.28 mg/kg/hr on the first postoperative day, and 0.29 mg/kg/hr on the second postoperative day. Ketamine blood levels ranged between 120 and 180 micrograms/L. None of the three analgesics caused any important hemodynamic or respiratory side effects. Pentazocine and piritramide were more effective analgesics than ketamine was. Ketamine also had a higher incidence of side effects.

Adult↗
PubMed1982

[The effect of fenoterol on the incidence of arrhythmias during Caesarean section (author's transl)].

Beta-sympathomimetic tocolysis is an important part of modern obstetric therapy. Severe cardio-vascular complications have been described however, when inhalational anaesthesia was given following fenoterol-verapamil therapy. Alterations in clinical; cardiovascular parameters were measured in a prospective study on healthy women who had to undergo caesarean section and who had been treated with fenoterol-verapamil until the time of anaesthesia. The patients were given either halothane or enflurane as inhalational anaesthetic, and either an atropine premedication or none at all. Severe cardiovascular disturbances such as frequent extrasystole, arrhythmias or marked falls in blood pressure were not noted either during induction, whether following atropine or not, or during the course of anaesthesia with either 0.5 vol% halothane or 1.0 vol% enflurane.

Anesthesia, General↗
PubMed1982

[Studies on the effectiveness of obstetric epidural analgesia. I. Vaginal delivery (author's transl)].

In a retrospective study 1,000 women who in 1979 had undergone a delivery either under epidural-anaesthesia or without, and instead either relation training or pethidine in small doses (20-30 mg i.v.) at the Ulm Department of Obstetrics, were followed up by questionnaire. The women of the epidural group felt that they had been adequately informed about the various possibilities of pain relief during labour, while some of the control group felt that they had been inadequately or even incorrectly informed. In the epidural group, pain relief during labour was such that 90% had hardly experienced any, or only mild discomfort, similar degree of pain relief was described by a many as 68.7% of the control group. Especially in the case of primigravida, the women of the epidural group had an insufficient urge to bear down, hence the rate of forceps delivery was relatively high, whereas this problem did not arise in the control group, where the forceps rate was markedly lower. The incidence of headache and back pain was only slightly higher in the epidural as compared to the control group, where other complaints were more frequent. 82% of the epidural group said that they would again choose this form of analgesia for future deliveries, 15% would not. In the control group 22% said that they would like an epidural for future deliveries, while 21% would not. The Apgar scoring and pH values of the newborn showed no significant differences between the groups.

Anesthesia, Epidural↗
PubMed1982

[Effectiveness of obstetric epidural analgesia. II. Caesarean section].

A questionnaire was sent to 260 women who in 1979 had undergone a caesarean section under either epidural or general anaesthesia. Those women who had an epidural for their caesarean section were on average very well informed about the procedure. In contrast, those who had been given a general anaesthetic felt that they had been badly or inadequately informed. Over 90% of the patients of both the epidural and the general anaesthetic groups described the type of anaesthesia which they had received as "very good" to "adequate". In the epidural group, 80% of the patients described the experience of the birth as very intense. Headache, back pain and other complaints such as abdominal pain and wound pain were significantly more frequent in the general anaesthetic as compared to the epidural group. 85.8% of the women given an epidural said that they would choose the same again for a future caesarean, 12.1% would not. Of the group given a general anaesthetic, 29.9% said that in the future they would choose an epidural, and 62.3% that they would prefer to have a general anaesthetic again. The Apgar score at one minute, and the umbilical artery pH values of the newborn of the epidural group were significantly better than those of the general anaesthetic group, whereas at 5 and 10 min the Apgar scores of the babies of both groups showed no differences.

Anesthesia, Epidural↗
PubMed1981

[Important metabolic parameters in the peripartum period as affected by peridural anesthesia].

In a clinical study we compared two groups of healthy patients at term: - 10 patients received no analgesics or very small doses of pethidine (control group) during the course of labour, - 17 patients were given CO2-bupivacaine via epidural catheter because they asked for it and because their obstetricians prescribed it (CEDA-group). After giving the same infusion solution of 120 ml/h 5% half-isotonic fructose to all the parturients, the following biochemical parameters were measured at the beginning and at the end of the first stage of labour, at delivery, and two hours later: Blood gases and acid-base status, blood sugar, lactate, betahydroxybutyric acid, ACTH, cortisol, hematocrit, electrolytes, and serum osmolality. The above mentioned parameters, except electrolytes and serum osmolality, were also determined in umbilical-cord blood immediately after delivery. In the labour ward, infants were observed and their capillary blood gases, acid-bases status, and blood sugar were measured 30, 60, and 120 minutes after birth. Lactate, betahydroxybutyric acid, ACTH, and cortisol levels rose significantly until delivery in both of the groups; significant differences between the two groups could be seen in blood gases, blood sugar, and ACTH levels. In the umbilical cord there were only significant differences in blood sugar. In summary it can be concluded that although labour pain can be controlled by epidural analgesia, the stress of labour is only influenced by different analgesic methods to a certain degree.

3-Hydroxybutyric Acid↗
PubMed1981

[The effect of preoperative food and fluid restrictions on various metabolic parameters in geriatric patients].

This clinical investigation was carried out in order to determine whether the 10-12 hr food and fluid restrictions imposed before elective operations have detrimental effects on older patients according to various metabolic parameters. Thirty male urological patients aged between 60 and 90 years were chosen for study (group I 60-70 years, group II 70-80 years, group III 89-90 years). The following parameters were measured at 7 p.m. the evening before the operation, and at 7. a.m. on the morning of operation: body weight, hematocrit, blood-gas analysis, electrolytes, serum osmolality, urea, creatinine, total protein with electrophoresis and blood glucose. Urine was collected during the period of abstinence and osmolality, electrolytes, total nitrogen, creatinine and urea were estimated. All patients showed a reduced creatinine clearance to a degree that was expected for their age. In all three groups a significant weight reduction (p less than 0,001) occurred during the time of observation. The 12 hr urine volume increased from one age group to the next whereas perspiration decreased, indicating deficient thermal regulations in older patients. The hypohydration on the morning of operation, especially in group II and III, marked a relatively lower hematocrit and hypoproteinemia. In all three groups the urea and creatinine values were slightly lower in the morning than in the evening before, indicating the occurrence of further hypohydration due to fasting. The low elimination of total nitrogen, urea, and creatinine in the urine could be an indication that the 12 hr food and fluid restriction caused no marked catabolism. Our study shows that geriatric patients are indeed able to compensate for a 12 hr-period of abstinence. When however, these patients also have to undergo an operation, possibly associated with a considerable loss of body fluids or when restriction of oral intake extends to 16-20 hrs, decompensation may rapidly occur leading to deleterious consequences.

Age Factors↗
PubMed1980

[Intensive care of acute respiratory distress syndrome in septic shock--a case report (author's transl)].

The acute respiratory distress syndrome being a critical complication of septic shock limits the patient's survival. A significant advance in treatment is the use of positive end-expiratory pressure ventilation (PEEP). As microthrombosis of the lung microcirculation seems to be one of the pathogenetic factors of RDS, fibrinolytic treatment may be tried as an additional therapeutic possibility, even in life-threatening situations. In this case we report on the treatment of shock lung resulting from septic shock occurring after diagnostic amniocentesis in the 16th week of pregnancy, this being a rare complication. By applying the principles of treatment described above --"Super PEEP" with 20 cm H2O and fibrinolysis with urokinase despite the presence of absolute contraindications--the respiratory insufficiency could be controlled.

Adult↗
PubMed1979

Influence of flunitrazepam on body functions.

The effects of intravenous flunitrazepam (Rohypnol, Roche) on various body functions were studied and the following conclusions were reached: it is a very potent sedative/hypnotic even in small doses, it may cause depression of spontaneous breathing, it does not give rise to raised cerebrospinal fluid or intra-ocular pressure, it does not adversely affect renal function, and it can be used quite safely in combination with fentanyl or pentazocine in anaesthetic practice.

Adult↗
PubMed1979

[Comparative studies during continuous epidural analgesia in obstetric (author's transl)].

From 1975 on, continuous epidural analgesia has been administered at the University Department of Anaesthetics in Ulm to women for pain relief during labour. One group of 350 pregnant women received bupivacaine hydrochloride, from 1. 5. 1976 to 30. 4. 1977, another group of 350 women received bupivacaine carbonate during the period from 1. 5. 1977 to 30. 11. 1977. Within these two groups the different effects of both local anaesthetic agents were compared in respect of the course of labour, the indications for epidural analgesia, the practicability of epidural analgesia, complications during labour, the rate of pain relief, the frequency of operative deliveries and the clinical condition of the newborn. The main advantages of bupivacaine carbonate for obstetric analgesia purposes are demonstrated.

Anesthesia, Epidural↗