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Biomedical subjects

G Hempelmann

Publications and source records attributed to G Hempelmann.

At least 523 records · Page 29Linked to original sources
PubMed1983

[Alfentanil, a new, short-acting opioid. Hemodynamic and respiratory aspects].

The haemodynamic and respiratory-depressive effects of 20 micrograms/kg and 40 micrograms/kg of alfentanil in 54 patients with coronary bypass operation were compared with a control group (n = 36). The measurements were carried out at 3 different times, each lasting over a 10 min period: 1. Before induction of anaesthesia but after premedication with flunitrazepam. 2. During anaesthesia and 3. during extracorporeal circulation (standardized conditions).--The preoperative as well as the intraoperative investigations showed a reduction in pulse rate, mean arterial pressure, left ventricular pressure and arterial perfusion pressure during extracorporeal circulation. As cardiac output remained constant in the awake patient, peripheral vasodilatation was predominant. Aside from this during anaesthesia reduction in cardiac output may have been responsible for the decrease in pressure although the cause of this could be the nitrous oxide as well. During the preoperative period a clear increase in wedge pressure, mean pulmonary artery pressure, right atrial pressure and pulmonary vascular resistance occurred from the 3rd minute after the injection. The cause is a vasoconstriction during apnoea. In the intraoperative period this did not occur. The respiratory depression(paO2: -34%, paCO2: +29%) resembles that after fentanyl, except that it starts earlier and lasts for a shorter time. In summary, it can be stated that all effects after alfentanil are similar to those of fentanyl.

Adult↗
PubMed1983

[Continuous peridural opiate administration with an implanted pump. Implantation technic and 1st results].

Epidurally administered opiates provide pain relief and may also be used for treatment of chronic pain of malignant origin. Compared to single-shot injection via externalized catheter continuous epidural morphine infusion via implantable pump and epidural catheter offers some advantages. The authors have used this method since October 1982. Functional characteristics of a low-flow continuous system, technique of implantation and preliminary results of this method are presented as a case report.

Aged↗
PubMed1983

[pH and buffer capacity of cerebrospinal fluid after spinal anesthesia].

In 20 patients, undergoing total hip or knee replacement, we studied pH and metabolic changes in the C.S.F. following spinal anaesthesia with two different mixtures of bupivacaine 0.5% and mepivacaine 4% hyperbaric. Our study was made with special regard to the early changes; therefore C.S.F. specimens were obtained at 1, 3, 5, 10, 20, 30, 60 and 90 min intervals and analyses of pH, pCO2, HCO3 and BE estimations were carried out immediately after each obtained sample. Our results showed a marked tendency towards acidosis and therefore do not comply with previous studies. The advantage of this fact is an improved stability of bupivacaine in C.S.F.

Aged↗
PubMed1983

[Effect of aspartate compounds on the biochemical characteristics of myocardial energy metabolism in man].

Twenty-five patients undergoing aortic valve replacement were administered two different electrolyte solutions pre- and intraoperatively: patients in group A (n = 9) received a balanced solution of electrolytes and trace metals with aspartate as anion (Inzolen), patients in group B (n = 16) received Ringer's solution with potassium chloride referenced to frequently-measured serum potassium levels. From the left ventricular apex region, needle biopsies were obtained at three points in time: 1. beginning of CPB, 2. end of ischemia, 3. after ten minutes of reperfusion. The tissue samples were enzymatically analyzed for the content of ATP, CP, ADP and lactate. In group A (patients with aspartate) ATP (moderately) and CP (markedly) decreased after ischemia with a marked increase after reperfusion. ADP and lactate in this group (A) increased at the end of ischemia and decreased after reperfusion. ATP and CP in group B (KCl) showed a similar course during the investigation. Lactate (markedly) and ADP (moderately) increased after ischemia without changing after reperfusion. Mean values of ATP and CP in group A were significantly higher than those of group B at all times. Mean values of ADP and lactate, however, in group A were below those of group B. The data indicate an improvement in energetic metabolism of myocardium in man. The results point out the possible importance of aspartates in compound with electrolytes and trace metals in preservation of biochemical energy.

Adenosine Diphosphate↗
PubMed1983

[Hemodynamic changes following the injection of lormetazepam under premedication and anesthesia conditions in coronary surgery patients].

Lormetazepam, a new short-acting benzodiazepine, was studied in 30 patients undergoing coronary artery bypass grafting (10 patients before induction of anaesthesia, 8 patients before extracorporeal circulation, 12 patients during extracorporeal circulation). Before induction of anaesthesia lormetazepam caused only a small reduction in CI, heart rate and a moderate hypoventilation. During anaesthesia (fentanyl, pancuronium bromide, ventilation with N2O/O2 1: 1) there was a decrease in CI (26%), SI (18%), HR (5,7%), dp/dt (15%) and an increase in TSR (25%) and TPR (32%); Part, PAP, PCWP and PRA remained unchanged. There was a small decrease in myocardial oxygen consumption. During ECC lormetazepam increased the arterial perfusion pressure (20%); the priming volume of the oxygenator decreased by 48% at the same time, indicating venous pooling.

Anesthesia, General↗
PubMed1983

[Evaluation of a new apparatus for determining sodium and potassium via ion-selective electrodes].

Evaluation of an apparatus for the direct measurement of sodium and potassium by means of ion-selective electrodes yielded very good results. This apparatus is notable for excellent linearity. It possesses a low detection threshold, the lowest identification limit being 4.43 mmol./l. for sodium and 0.21 mmol./l. for potassium. The sensitivity is high, since it is approximately 1.5 mmol./l. for sodium in whole blood and approximately 0.15 mmol./l. for potassium. On checking the accuracy of the instrument, a mean recovery of 100% was seen for both electrolytes. An examination of the precision of the instrument yielded, in serial determinations of sodium, variation coefficients between 0.2 and 0.4%, and in case of potassium, variation coefficients around 1%; even in respect of day-to-day precision, all variation coefficients were definitely below 5%. Hence, the overall precision of the apparatus can be rated as good. However, when using whole blood samples anticoagulated with sodium heparinate solution, it is necessary to take the dilution effect into account when arriving at the potassium value.

Blood Chemical Analysis↗
PubMed1983

[Changes in plasma amino acids during and following isolated liver perfusion in the human. Brief clinical report].

Plasma amino acids have been analysed during isolated perfusion of the liver in dogs. Aromatic amino acids increased, also the branched chain amino acids showed a small rise. Thus no signs of hepatic failure could be detected. To evaluate early signs of hepatic failure in 2 patients scheduled for isolated liver perfusion, the plasma amino acids where analysed. Corresponding to the results obtained in animals, aromatic acids increased, whereas branched chain amino acids remained constant or rose. Even in the postoperative course no signs of deterioration of plasma amino acids could be detected.

Amino Acids↗
PubMed1983

[Effect of neuroleptanalgesia on operation-induced rise in the antidiuretic hormone].

Plasma-levels of antidiuretic hormone were measured in patients undergoing major abdominal surgery pre-, intra- and postoperatively. All patients (n=20) received neuroleptanalgesia as anaesthetic procedure; 10 of them received etomidate additionally. Initial value of vasopressin as well as values after induction of anaesthesia stayed within normal range in all patients. The operation period was accompanied by elevated ADH-levels with a maximum of 500% above initial values. 5 patients having been antagonized postoperatively with naloxone 0.005 mg/kgbw showed marked increase in ADH-level. In comparison to former investigations we conclude that NLA can not block stress-induced rise in vasopressin-concentration effectively as seen under the combination of NLA plus epidural analgesia.

Abdomen↗
PubMed1983

Influence of epidural fentanyl on stress-induced elevation of plasma vasopressin (ADH) after surgery.

The role of techniques used for management of intra- and postoperative pain on plasma levels of antidiuretic hormone (ADH) was evaluated in 107 patients undergoing abdominal or thoracic surgery. Fifty-one patients had neurolept-anesthesia (NLA) intraoperatively followed by intramuscular piritramide, a long-lasting synthetic narcotic, for relief of postoperative pain. Fifty-six patients had a combination of epidural bupivacaine and NLA intraoperatively followed by epidural fentanyl for relief of postoperative pain. All patients had daily measurements of serum levels of potassium and sodium, plasma levels of ADH, and plasma osmolality for the first 5 postoperative days. In 67 patients arterial blood-gas tensions also were measured at similar times. There were no significant changes in serum electrolyte levels, plasma osmolality, or blood-gas tensions intra- or postoperatively. Plasma ADH levels increased postoperatively in all patients, but in patients given NLA followed by postoperative intramuscular narcotics, plasma levels of ADH were more than twice as great as in patients given epidural anesthesia followed by epidural fentanyl.

Adult↗
PubMed1983

[Pathophysiology of thoracic injuries].

A systematic review of the pathophysiology of thoracic injuries has not yet been published. As an introduction all kinds of injuries of the chest are listed. The causes of the so called "acute thorax" are described. Furthermore three cardinal symptoms which occur after thoracic trauma are distinguished and explained: hemorrhagic shock, the combination of venous congestion and low cardiac output (which is very similar to cardiogenic shock) and hypoxia. A short description of the pathophysiology of the acute respiratory distress syndrome (ARDS) is given. The review ends with some remarks to the therapeutic management of chest injury and to the aftereffects of initial therapy.

Acute Disease↗
PubMed1983

[Anesthesia procedure and postoperative ADH secretion].

44 patients undergoing major abdominal and thoracic surgery received different anaesthetic treatment and different pain therapy during the postoperative period (4 groups). Analysis of plasma vasopressin was performed in all patients pre-, intra- and five days postoperatively. In two groups of patients under neuroleptanalgesia (group A and B) ADH-levels increased markedly during the operation procedure, whereas those of patients under NLA plus epidural analgesia with bupivacaine 0.5% (group C and D) showed only a slight increase intraoperatively. During the postoperative period pain relief was provided by giving fentanyl epidurally (group B and D) or with systemic administration of piritramide (group A and C). During the investigation period vasopressin secretion in patients under epidural opiate therapy was significantly less pronounced as in patients under systemic opiate therapy.

Analgesia↗