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Biomedical subjects

G Hempelmann

Publications and source records attributed to G Hempelmann.

At least 541 records · Page 30Linked to original sources
PubMed1982

[Influence of different preinjections on unfavourable side-effects of succinylcholine-induced block (author's transl)].

Pretreatment with a subparalytic dose of a nondepolarizing relaxant is used to prevent side-effects of the succinylcholine (Sch) dose needed for intubation. On the other hand small doses of Sch (self-taming) or lignocaine are recommended to avoid in part reversal of the Sch-induced block caused by nondepolarizing relaxant. 50 patients received different preinjections before Sch-induced relaxation: 2 mg alcuronium, n = 10; 1 mg pancuronium, n = 10; 0.1 mg/kg bw Sch, n = 10; 1 mg/kg bw lignocaine, n = 10; no pretreatment, n = 10. Injection of small doses of Sch or lignocaine prior to the Sch dose needed for intubation, offered no advantage in comparison to the conventional method of pretreatment with nondepolarizing relaxant, concerning intensity and duration of the relaxation, conditions for intubation and muscle fasciculations. After preinjection of Sch or lignocaine a similar rise of serum potassium was observed as without preinjection (0.4-0.5 mEq/l).

Humans↗
PubMed1982

[Antidiuretic hormone in peridural anesthesia with 0.5% bupivacaine. The effect of severe blood loss on ADH release].

14 patients scheduled for peripheral vascular surgery received epidural anaesthesia with bupivacaine 0.5%. Blood samples were obtained preoperatively (twice), intraoperatively (9 times) and postoperatively (3 times) for analysing the following parameters: 1. antidiuretic hormone (ADH, arginine-vasopressin) 2. serum electrolytes (potassium, sodium) 3. plasma osmolality In three patients unexpected sudden blood loss occurred, accompanied by typical haemodynamic changes. Pre- and intraoperative ADH-levels were normal with a slight increase at the end of the operative procedure. Electrolytes and osmolality in serum/plasma stayed within the normal range during the whole investigation period. In three patients suffering from shock due to unexpected blood loss ADH-levels rose excessively. The data demonstrate the well-known stress-attenuation under EDA as well as an increase of ADH-secretion in haemodynamic alteration.

Anesthesia, Epidural↗
PubMed1982

[Effect of neuroleptanalgesia on the visual evoked potential (VEP) in man].

Visual evoked potentials (VEP) were monitored intraoperatively in 35 urological patients during modified neuroleptanalgesia. Control measurements were made in 18 awake, premedicated patients prior to induction of anesthesia. The latencies of the negative peaks (designed n1, n2, n3) increased significantly (p = 0.001) during anesthesia: n1 from 50,6 ms to 57,1 ms, n2 from 80 ms to 89,4 ms, n3 from 124,5 ms to 139,6 ms, no significant change in amplitude was seen. Changing paCO2 in the range from 20 mmHg to 50 mmHg during controlled ventilation did not affect latencies and amplitudes of visual evoked potentials (n = 10 patients). These influences of neuroleptanalgesia must be considered when recording visual evoked potentials intraoperatively during neurosurgical procedures (aneurysm-, pituar gland surgery) for monitoring optic nerve function.

Adolescent↗
PubMed1982

[Modified neuroleptanalgesia with buprenorphine].

A modification of neuroleptanalgesia by substituting fentanyl with buprenorphine is presented. Both anaesthesia techniques could be applied alternatively. We did not recognize any significant difference between the two groups concerning haemodynamics, the secretion of the so called stress hormones (antidiuretic hormone, cortisol) as well as the postoperative respiratory depression. The long lasting analgesia, which could be achieved by buprenorphine, can be advantageous in certain surgical interventions. The lack of a potent antagonist for buprenorphine in addition to its longer half-life for--not being of advantage in any anaesthesia--is discussed.

Adult↗
PubMed1982

[Variations in vasopressin (ADH)-levels during NLA combined with epidural fentanyl-analgesia (author's transl)].

10 patients scheduled for thoracic, abdominal or vascular surgery received anaesthesia as a combination of neuroleptanalgesia plus epidural opiate-analgesia. Antidiuretic hormone levels (ADH), serum-electrolytes (Na+, K+) and plasma osmolality have been investigated preoperatively (twice), intraoperatively (six times), during the first postoperative day (three times) and for five days postoperatively (once a day). There was a significant increase in ADH in all patients intra- and postoperatively, whereas serum-electrolytes and plasma-osmolality stayed within normal range. Maximum ADH-values were measured during the intraoperative period, postoperatively ADH-levels reached the normal range after 5 days. This increase in plasma-ADH-levels was not accompanied by typical haemodynamic changes. From the aspect of metabolic endocrine response to surgery, our results indicate no advantage of the combination of neurolept-analgesia plus epidural opiate-analgesia for the intraoperative period.

Aged↗
PubMed1982

[Haemodynamic effects of fentanyl in man during cardiac surgery (author's transl)].

In 93 cardiac patients the effects of low, mean and high fentanyl dosage--0.003 mg/kg, 0.015 mg/kg and 0.03 mg/kg--on haemodynamics, inotropic state and myocardial oxygen consumption were investigated during surgical procedures under basic neuroleptanalgesia. There was an increase in heart rate with the low fentanyl dosage, whereas mean and high doses lowered heart rate. Decreases in arterial pressure, left ventricular pressure, and perfusion pressure during extracorporal circulation as well are interpreted as peripheral vasodilatory effects. Most of the measured and calculated hemodynamic parameters such as PAP, dp/dtmax, CI, TSR decreased. There was, however, no decrease in myocardial contractility, when considering changes in heart rate, pre- and after-load and dp/dtmax. The decrease in heart work and myocardial oxygen consumption may be of advantage especially in patients with coronary heart disease.

Animals↗
PubMed1982

[Hemodynamic and respiratory effects of tramadol during nitrous oxide-oxygen-artificial respiration and in the postoperative period].

The haemodynamic effects of intravenous tramadol (two different doses: 0.75 mg/kg b.w. or 1.5 mg/kg b.w.) during artificial ventilation with oxygen and nitrous oxide were investigated in 20 female patients before the start of operation. Haemodynamic changes were characterized by a moderate increase in blood pressure concerning systemic as well as pulmonary circulation. These effects were due to a rise in peripheral and pulmonary vascular resistance. Application of tramadol immediately after the end of operation (n = 20:10 patients following neuroleptanalgesia and 10 patients after anesthesia with halothane) led to a slight antagonizable decrease in respiratory frequency and respiratory amplitude as well as increase in paCO2. While during conventional pain-therapy no haemodynamic and respiratory side-effects of tramadol could be demonstrated, the typical qualities of opiates (postoperative ventilatory embarrassment) and unspecific adrenergic effects have to be taken into account after use of high doses for anaesthetic purposes.

Anesthesia↗
PubMed1981

[Treatment of the polytraumatic shock (author's transl)].

The survival rate of patients with multiple injuries can be improved by means of the modern possibilities of rescue services. The timespan preceding treatment can be shortened. A consequent symptomatic treatment of hemodynamic and respiratory disorders plays an important role. A causal therapy of the impaired permeability of the capillaries, which causes the shock, is possible only to some extent. The therapy should concentrate on the solution resulting from shock.

Blood Transfusion↗
PubMed1981

[Roentgenographic pulmonary findings in long term ventilated multiple trauma patients (author's transl)].

An analysis of roentgenographic pulmonary findings was done in 46 multiple trauma patients on controlled long term ventilation. 67% of the patients sustained thoracic trauma. The most common lung changes were interstitial and intraalveolar pulmonary edema and inflammatory pneumonia related to contusions, atelectasis and aspiration. The pulmonary lesions predominantly occurred in the middle and lower portions of each lung. The thoracic trauma group had four times as many lung changes than the non-thoracic trauma group. Daily roentgenographic controls are necessary in multiple trauma patients to explain a deterioration in pulmonary gas exchange leading to respiratory failure. To demonstrate discrete lesions in lung parenchyma, we recommend the high voltage technique for chest X-rays in intensive care units.

Adolescent↗
PubMed1981

[Preparation for anesthesia and surgery of the aged patient with circulatory disease (author's transl)].

Higher life-expectancy and progresses in operative medicine and anaesthesiology increasingly confront the anaesthesist with the necessity of performing anaesthesia in elderly patients. The most frequent disease in this group of patients are related to the cardiovascular system (hypertension, coronary heart disease, arrhythmia and myocardial insufficiency. Preoperative cardiovascular therapy with regard to anaesthesia is outlined.

Adult↗
PubMed1981

[Value of morphine derivatives administered by the peridural route per- and postoperatively].

The existence of opiate receptors in the spinal cord led the authors to seek a clinical application. 1 - A peroperative injection of morphine was administered in 170 cases: 0.005 mg/kg of fentanyl in 105 cases and 0.05 mg/kg of morphine in 65 cases. In addition to usual surveillance (blood pressure, heart rate and central venous pressure), more extensive haemodynamic investigations were undertaken in 20 patients using a Swan-Ganz catheter. Blood concentrations (11 cases) and CSF concentrations (2 cases for each time of measurement) were determined in the case of fentanyl. In 20 patients (10 of whom had received fentanyl and 10 morphine) there was sophisticated cardio-respiratory surveillance postoperatively. 2 - 0.05 mg/kg or morphine (404 cases), 50 mg of pethidine (10 cases) and 0.1 mg of fentanyl (10 cases) were injected postoperatively. A comparison was made of the analgesia obtained. After three types of anaesthesia: epidural with bupivacaine with intubation (10 cases), halothane with intubation (10 cases) and neuroleptanaesthesia (10 cases), an injection was given of 0.05 mg/kg of morphine, with cardiorespiratory surveillance. Results were as follows: 1 - There were no significant variations in haemodynamic parameters peroperatively, indicative of adequate analgesia. Blood concentrations of fentanyl were as follows: 3.2 +/- 2.1 ng/ml after 10 minutes, 2 +/- 1.7 ng/ml after one hour, 1.4 +/- 1 ng/ml after two hours and 0.4 +/- 0.3 ng/ml after four hours. CSF concentrations were much higher; 34 ng/ml after one hour, 30 ng/ml after two and three hours and 25 ng/ml after four hours. No cardio-respiratory depression was seen after the peroperative injection of morphine. 2- The duration of analgesia following a postoperative injection of a morphine derivative was as follows: morphine 17.3 +/- 3.9 hours, pethidine 3.5 +/- 0.5 hours, and fentanyl 5.1 +/- 0.7 hours. The epidural injection of morphine after neuroleptoanaesthesia caused respiratory depression in two of the 10 cases, with a rise in pCO2 of 0.45 and 0.52 KPa. The results are discussed and compared with those of other authors. In conclusion, the authors emphasize the advantages of this method which makes it possible to obtain with smaller doses analgesia of longer duration than following a systemic injection of morphine, whilst at the same time decreasing the side effects.

Anesthesia, Epidural↗