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Biomedical subjects

E Knoche

Publications and source records attributed to E Knoche.

32 records · Page 2Linked to original sources
PubMed1978

[Effects of diazepam and flunitrazepam on the undesired postoperative side-effects of ketamine anaesthesia (author's transl)].

150 patients undergoing minor gynaecological procedures (curretages) were anesthetized with ketamine and either diazepam flunitrazepam or placebo in order to establish the best combination for the prevention of postoperative psychotomimetic effects. From observations, up to 24 h after operation, it was found and statistically proven that the combination of ketamine/flunitrazepam as compared to the combinations ketamine/diazepam and ketamine/placebo led to a remarkable reduction of psychotomimetic side reactions.

Adult↗
PubMed1978

[Possibilities and limitations of peripheral-venous parenteral feeding].

The possibilities of peripheral-venous nutrition as regards its substrate dosage are limited due to the vein tolerance (osmolarity) of the infusion mixtures. It is, therefore, imperative to achieve an optimum composition of the solution for obtaining the most favourable utilization rate for the organism. We have shown that a dosage below 0.6 g amino acids/kg BW per day does not have a positive influence on the nitrogen balance in comparison to a control group not nourished. The situation of a patient in the post-aggression phase results in 30 to 40% of the supplied amino acids being utilized in the energy metabolism and excreted as urea, in spite of a sufficient simultaneous energy supply. Not only does this uneconomical loss alone necessitate a higher amino acid dosage, but also the additionally increased catabolism of endogenous protein reserves in the post-operative phase. It remains to be tested whether the sole substitution of amino acids in a solution without carbohydrates over a short infusion period constitutes a compromise between the intended peripheral-venous tolerance and an effect on the nitrogen balance.

Amino Acids↗
PubMed1978

[Changes in intraocular pressure with various concentrations of enflurane during constant conditions of ventilation (author's transl)].

A variety of factors influence intraocular pressure. An increase for example, can be found under conditions of hypoventilation, prohibited ventilation and too light anaesthesia. Some pressure decreasing factors are barbiturates, various inhalation anaesthetics, neuroleptics, and also hyperventilation. In 10 gynaecological patients with normal ophthalmological status, IOP was measured under enflurane anaesthesia by means of a Draeger hand-held applanation tonometer. The neuroleptanaesthesia served as a basis. After anaesthetic conditions were stabilized, concentrations of enflurane ranging from 0.5 to 2.0 vol.% were administered. Under constant ventilation (PECO2) the following parameters were measured: pH, PCO2cap,PO2cap,base excess, minute ventilation, respiratory rate, blood pressure and pulse rate. The concentration of enflurane was measured by gas-chromatography. The IOP was decreased by using enflurane in various concentrations. This decrease is caused by enflurane/itself and is independent of blood pressure changes.

Adolescent↗
PubMed1978

[The anaesthesia outpatient clinic. A new concept of preanaesthetic preparation and treatment after two years experiences (author's transl)].

The anaesthesia outpatient clinic can be a new concept of preanaesthetic preparation and treatment. Related to the figures of 1977, a report is given about our 2-years experience. Patients from the usual outpatient clinics, like gynecology, urology, ENT, who are expected to be operated upon are immediately sent to the anaesthesia outpatient clinic for preanaesthetic check up. After the overall state of the patient has been examined, the original outpatient clinic and/or the family doctor are given information about the patients condition, and probably proposals for a preanaesthetic treatment are made. In 1977, 15% of all anaesthetized patients were checked as outpatients, another 40% were only examined after entering the hospital, whereas as few as 17% were not checked in the anaesthesic outpatient clinic. In patients, checked as outpatients, the period between the first day of hospitalisation and operation was evidently shorter than in patients, having been hospitalized at the time of preanaesthetic examination. This gives the opportunity to save money and beds. Furthermore, the anaesthesia outpatient clinic improves the organisation and efficiency of surgery, urology, gynecology etc., improves the relationship between patients and anaesthetists, decreases the risk of anaesthesia and operation, saves personnel and gives a qualified additional background for the purposes of graduation and student training.

Anesthesia Department, Hospital↗
PubMed1977

[Changes of the blood gases following the application of naloxon (author's transl)].

74 patients, undergoing gynaecological operations under neuroleptanesthesia were subdivided into 4 groups, each receiving Naloxone in different doses postoperatively. For a longer period of time tidal volume, respiratory rate, minute ventilation, blood gas volues and pain index were recorded. From the results one can conclude that 0.1-0.2 mg Naloxone i.v. seems to be the most effective dose to reverse opiate-induced respiratory depression. The initial i.v. dose should be followed by an i.m. dose of 0.2 mg, if required.

Blood Gas Analysis↗
PubMed1977

[Apgar status, blood gases and acid base balance of neonates after caesarean sections, using either thiopentone or ketamine for induction of anaesthesia (author's transl)].

Apgar status and acid base balance of 206 neonates, delivered by caesarean section under general anaesthesia, were investigated in order to compare the possible effects of either thiopentone- or ketamine-induction on the postpartum adaption. Several other criteria were recorded also, for instance, a possible neonatal asphyxia, the induction-delivery-interval, the maternal age, the administration of other than anaesthetic drugs etc. There were not correlations between the Apgar status and the induction-delivery interval in either groups. The number of neonates within the 3 Apgar-classes, and the asphyxiated neonates, were equally distributed in the thiopentone- and ketamine-groups. There was no correlation between maternal ages and either the thiopentone- or ketamin-babies, but a marked correlation with the number of depressed newborns. Those neonates, who were suspected to be hypoxic before anaesthesia showed a more depressed post-partum respiration after thiopentone- than after ketamine-induction. On the other hand it seems to be that neonatal respiration and total Apgar status was more depressed if the "ketamin mothers" were treated with sedatives, hypnotics and/or analgesics before caesarean section. The blood gas values and the acid base parameters did not show a statistically significant difference between the pH of the thiopentone- and the ketamine-neonates. These differences can be explained as the combination of the nonsignificant changes in PCO2 and standard-bicarbonate values. As far as can be judged from the above mentioned criteria it may be deduced that ketamine or thiopentone can equally well be used for inducation of anaesthesia for caesarean section.

Acid-Base Equilibrium↗
PubMed1977

[Clinical studies on analgesia in obstetrics using intravenous administration of droperidol and pethidin (author's transl)].

In 70 healthy women under labor, the clinical properties of the combination DHB (0,1 mg/kg) and Pethidin (0.4 mg/kg) was studied for analgesia purposes in obstetrics; on request, Pethidin was given repeatedly. The fallowing conclusions can be drawn from this study: 1. The recommended "analgesic mixture" of DHB and Pethidin i.v. in the above mentioned doses is usually without harm to mothers and fetuses or new born respectively. 2. The Pethidin dosage, used in this study, agrees with the doses, recommended in the literature (0,4 mg/kg/h). 3. There was no difference between I-para, II, III-para etc., as far as the Pethidin requirement are concerned. 4. The analgesic properties of the mixture, judged by using clinical criteria only, were not quite convincing. This may be due to an increase of the intensity of uterine contractions by the mixture itself.

Adult↗
PubMed1976

[Clinical studies on the use of ketalar in obstetric anesthesia (author's transl)].

26 healthy pregnant women at term were divided into 2 groups and anaesthetized with either 1 mg/kh or 2 mg/kg ketamine - N20/02 - for primary caesarean section. Maternal venous ketamine plasma levels, neonatal ketamine plasma levels (umbilical artery and umbilical vein) and blood gases were measured. Maternal venous ketamine plasma levels in group I exceeded those in group II by 2.8 (30-60 sec after injection) and 2.0 (at the time of delivery) respectively. Independent of the dose used, the plasma levels of ketamine in the umbilical artery or the umbilical vein were found to be identical in the two groups of newborn infants. Neonatal blood gases and acid base parameters did not significantly differ between the two groups, except for the oxygen tension in group II which slightly exceeded the PO2 values in group I 15, 60 and 120 min after delivery. pH and standard bicarbonate values were found to be higher (1 and 5 min) in both groups, compared to pH and standard bicarbonate levels in a group of newborns delivered spontaneously.--The results of this study show: 1. Independent of a low or high ketamine dosage, neonatal blood concentration of the drug remain low, probably due to a placental barrier effect.--2. The post partum recovery of the newborns was neither influenced by the ketamine anesthesia itself nor by different drug doses.

Anesthesia, Obstetrical↗
PubMed1975

[Metabolic behavior and utilization of parenterally administered carbohydrates in the postoperative phase].

60 patients who had to undergo the same operation were subdivided at random into five groups. Each group obtained in respect to the part of carbohydrates a different infusion solution (5% glucose, 5% fructose, 5% xylitol, 5% xylitol-glucose-fructose, 5% sorbitol) with an always constant part of electrolytes, the dosage of which was 60 ml/kg body weight on the day of operation and 40 ml/kg body weight during the first 3 postoperative days being continuously distributed over 24 hours. From the day before the operation until the third postoperative day the effects on metabolic parameters (lactate, uric acid, blood glucose and others) as well as the utilization of the different energy carriers were investigated. While after a glucose infusion, due to a reduced utilization, no change of the lactate level could be proved in the postoperative phase, the effect of fructose on the lactate concentration was most evident. The administration of xylitol was followed by a small increase of the serum uric acid on the first and second postoperative day, whereas in the other groups its decrease could be proved - there was no change after the administration of sorbitol. The highest blood glucose levels were found in the group to which glucose and the three-part solution of xylitol-glucose-fructose were administered. About the utilization of the different energy carriers only a limited information could be given. Altogether the results allow the conclusion that a combination of xylitol, glucose, and fructose or alternatively sorbitol can be considered the most favourable carbohydrates for preparing an isotonic base electrolyte solution.

Adult↗