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Biomedical subjects

G Hempelmann

Publications and source records attributed to G Hempelmann.

At least 559 records · Page 31Linked to original sources
PubMed1981

[Comparative haemodynamic studies with mexiletine and lidocaine in patients with coronary heart disease after aorto-coronary bypass (author's transl)].

In two patient groups undergoing coronary surgery (n = 10) hemodynamic side effects of mexiletine and lidocaine were investigated. Changes of clinical importance were seen in cardiac-output, stroke volume, total peripheral resistance, triple- and cardiac index. There are significant differences 10, 15, and 30 min after application (p less than 0.05; p less than 0.025) in cardiac-index.

Cardiac Output↗
PubMed1981

[Haemodynamic effects and characteristics of midazolam during induction of anesthesia (author's transl)].

Our investigations have shown the following: 1. 8-Chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a] [1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) produces no adverse haemodynamic changes in healthy subjects. 2. The reduction in peripheral resistance becomes apparent mainly in the case of raised baseline values, as, for example, in hypertensive subjects, but it can also be of significance prior to anaesthesia, when there may be raised systemic vascular resistance due to stress. 3. Venous pooling, which leads to a decrease in pre-load and subsequent lowering of the cardiac index, can have a compensatory effect in cardiac insufficiency. Under certain conditions, as for example, in the case of imminent volume deficit, a marked fall in pressure is to be expected. 4. The haemodynamic effects of midazolam are thus limited to vascular reactions. Under certain circumstances volume therapy may be necessary before the drug is used.

Adult↗
PubMed1981

[Cardiac and vascular effects of midazolam during induction of anesthesia prior to and during extracorporeal circulation in coronary-surgical patients (author's transl)].

8-Chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a] [1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) is a new benzodiazepine which, when compared with its predecessors diazepam (Valium) and flunitrazepam (Rohypnol), has several outstanding advantages: We conducted hemodynamic investigations with 0.15 mg/kg b.w. midazolam in a total of 28 coronary patients divided into 3 groups. The new water-soluble benzodiazepine is at the dose given useful in the induction of and as an adjuvant to anesthesia because of its hemodynamic effect.

Anesthetics↗
PubMed1981

[Comparative clinical investigations on the cardiovascular effects of piritramide (dipidolor) and fentanyl (author's transl)].

In 36 patients with acquired heart disease effects of 0.15 mg/kg piritramide on hemodynamics, inotropic state and myocardial oxygen consumption were investigated during and after cardiac surgery (basic neuroleptanalgesia). It could be demonstrated, that piritramide is not inducing any negative inotropic effects compared to a control group (n = 36) and a fentanyl group (0.003 mg/kg, n = 31). There were only small changes in HR, SV, PRA and PLA. A slight decrease in Part, PLV, and arterial perfusion pressure during extracorporeal circulation is interpreted as a peripheral vasodilatation. The resulting decrease in heart work caused a significant decrease in myocardial oxygen consumption (-18%), which is of special advantage in patients with coronary heart disease.

Anesthesia, General↗
PubMed1981

[Epidural morphine as adjunct to epidural anaesthesia in obstetrics (author's transl)].

Epidural opiate as a single analgesic during labour failed to relieve pain sufficiently. According to a synergistic effect of epidural opiate and local anaesthetic a combination of both drugs appears to be useful for obstetric analgesia. In a double-blind-study a single epidural morphine-application at an early stage of labour led to prolonged intervals of reinjection during conventional epidural anaesthesia with bupivacaine. The reduced dosage of local anaesthetic improves neonatal status and reduces the necessity of extractional aids. In addition the long-lasting postpartum pains. Side-effects, such as vomiting and pruritus, are rare.

Anesthesia, Epidural↗
PubMed1981

[Haemodynamic effects of morphine in man (author's transl)].

In 52 patients with acquired heart disease haemodynamic effects of 0,2 mg/kg and 1,0 mg/kg morphine were investigated during surgical procedures under neuroleptanalgesia. The following parameters were measured or calculated: heart rate (HR), arterial pressure (Part, Psyst, Pdiast), pulmonary artery pressure (PAP), right (PRA) and left atrial pressure (PLA), left ventricular pressure (PLV), left ventricular end-diastolic pressure (PLVED), left ventricular peak dp/dt (dp/dtmax), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), total systemic resistance (TSR), total pulmonary resistance (TPR), work index of the right (RVWI) and left ventricle (LVWI). Myocardial oxygen consumption (EG) was calculated according to the method of Bretschneider. There was almost no change in cardiac index and stroke index. In comparison to a control group (n=36) morphine caused a dose-dependent decrease in arterial pressure and in arterial perfusion pressure during extracorporeal circulation. This, however, was mainly attributable to vasodilatation and not to a negative inotropic effect. In accordance with the changes in haemodynamics there was a remarkable decrease in myocardial oxygen consumption (EG: -21.1%; 1,0 mg/kg morphine).

Adult↗
PubMed1981

[Labetalol for the management of hypertensive crises during surgery of cerebral aneurysm; a haemodynamic study (author's transl)].

The haemodynamic effects of Labetalol, an alpha- and beta blocking agent were investigated during neurosurgery in 11 patients with cerebral aneurysm and hypertensive episodes. All operations were performed in neuroleptanalgesia and controlled ventilation (PaCO2 = 30 mmHg). Immediately after intravenous injection of Labetalol there was a significant fall in the following haemodynamic parameters: arterial pressure -20 percent, pulmonary artery pressure -17 per cent, heart work index (right ventricle -32 percent, left ventricle -30 percent) and cardiac effort index -25 percent. Heart rate, cardiac index, stroke volume, total systemic and total pulmonary resistance were not appreciably altered. Labetalol appears to be of value in neurosurgical operations, where an increase in blood pressure, heart rate and myocardial oxygen consumption is undesirable.

Adolescent↗
PubMed1981

[Epidural application of opiates in chronic pain due to malignoma (author's transl)].

In 75 patients epidural opiates were applied for relief of chronic cancer pain. In order to avoid local infection during long-term therapy part of the catheter was placed subcutaneously. Different opiates were used separately or in combination with local anaesthetics to define the degree and duration of pain relief after epidural opiate application. Haemodynamic and respiratory parameters, changes in lower extremity blood supply and other side-effects were recorded during epidural pain therapy. Epidural opiate application cause a long-lasting reduction of pain, which may become restricted during long-term or repeated use, especially after a period of systemic opiate therapy. Side-effects, for example slight respiratory depression in the first hour after injection, indicate an initial phase of resorption beeing followed by a long-lasting reduction of pain without attendant symptoms. Keeping in mind certain precautions epidural opiate therapy is superior to systemic opiate application.

Adult↗
PubMed1981

[Epidural opiates for relief of chronic pain (author's transl)].

Epidural opiate application was performed in 75 patients with chronic pain due to abdominal cancer. To reduce the risk of local infection, the epidural catheter was in part placed subcutaneously. Degree and duration of analgesia were determined after epidural morphine (with and without bupivacaine), pethidine or fentanyl. Hemodynamic and respiratory parameters were measured and side-effects were registered. The longest duration of analgesia was observed after epidural morphine. In long-term treatment there was a reduced efficiency and the frequency of daily injections increased, especially in those patients who already had received systemic opiates prior to the epidural opiate administration. This may be due to tolerance of the spinal receptors. A combination of epidural morphine with small doses of local anesthetics caused prolonged action and delayed the onset of tolerance. Besides slight influences on respiratory function, which may be referred to the initial period of systemic absorption, there were no relevant side-effects. Regarding certain precautions the epidural application of morphine may have advantages in comparison to systemic analgetics in treatment of chronic pain.

Abdominal Neoplasms↗
PubMed1981

[Plasma antidiuretic hormone level as an indicator of perioperative stress (Part I) (author's transl)].

The secretion of antidiuretic hormone (ADH) is mainly influenced by changes in osmolality and blood volume. In addition stress and surgical trauma may cause an elevation in plasma-ADH levels. In 20 patients scheduled for similar surgical procedures two different anaesthesia techniques were applied: in group 1 (n = 10) a combination of peridural anaesthesia and neuroleptanalgesia (PDA/NLA) was performed, in group 2 halothane anaesthesia with intubation was used. The perioperative control of plasma-ADH levels demonstrated a smaller increase in group 1 (PDA/NLA) compared to group 2 (Halothane), thus implicating a better attenuation of stress and pain.

Adolescent↗
PubMed1981

[Plasma-antidiuretic hormone level as indicator of postoperative stress (part II) (author's transl)].

For a period of five days serum levels of antidiuretic hormone (ADH) have been investigated postoperatively in a group of 20 patients with upper abdominal surgery. In addition serum electrolytes (Na+, K+) and plasma osmolality have been controlled regularly. Patients in group A (n = 10) received Fentanyl epidurally (0.1-0.2 mg diluted with 0.9% saline solution) for treatment of postoperative pain, whereas in group B (n = 10) systemic opiate therapy was performed by intramuscular application of piritramide (Dipidolor, 15-25 mg). There was a significant increase in ADH in all patients, whereas serum electrolytes (Na+, K+) and plasma osmolality stayed within normal range. ADH-levels in group A (epidural opiate), however, were significantly lower than mean values in group B (systemic opiate application). The postoperative increase in ADH is interpreted as a reaction to stress and trauma, being less pronounced, when epidural opiate therapy is performed for postoperative pain treatment.

Adult↗
PubMed1980

[Hemodynamics and pulmonary gas exchange in radiographically observed posttraumatic lung edema (author's transl)].

A prospective study of 46 multiple trauma patients was undertaken using standard intensive care techniques with special circulatory and respiratory monitoring. In 19 cases roentgenograms detected at least temporary pulmonary edema; only 3 of these patients sustained no discernible lung contusions. The hemodynamic data did not explain the pulmonary edema. Despite ventilatory support of all patients, pulmonary gas exchange was abnormal prior to radiological findings of pulmonary edema. The most significant explanation of the investigated data is early capillary leakage in the lung inducing an enlarged transit space at the interstitial site.

Adolescent↗
PubMed1980

[Intraoperative peridural opiate analgesia (author's transl)].

Epidural injection of small doses of opiates causes a reduction of pain in the lower parts of the body. The use of epidural opiate-analgesia for surgical anesthesia, combined with controlled ventilation (oxygen-nitrous oxide), was investigated in 170 patients undergoing surgery, especially long lasting gynaecological operations. Haemodynamic monitoring demonstrated a constant cardiovascular situation, underlining the sufficiency of analgesia. Blood gas analyses for one hour after the operation revealed no signs of respiratory depression. The epidural opiate-analgesia outlasted the intraoperative period, covering even the postoperative phase.

Anesthesia, Epidural↗
PubMed1980

[The effects of dihydroergotamine on the circulatory system of man during neurolept analgesia (author's transl)].

The effect of 0.015 mg/kg KHE i.v. on the circulatory system was investigated in 10 patients after closure of an atrial septal defect under neuroleptanalgesia. The arterial pressure increased due to an increase of total systemic resistance. The filling pressures of the right and the left ventricle increased while the stroke index remained unchanged. The maximal rate of rise of left ventricular pressure did not change despite the marked changes of pre- and afterload. The data support the drug mechanism of a volume shift from the peripheral to the central circulation. The possible reasons for the missing stroke index increase are discussed.

Adult↗
PubMed1980

[Epidural opiate analgesia (EOA), compatibility of opiates with tissue and CSF (author's transl)].

To estimate the compatibility of opiates with tissue we measured the pH of opiate solutions in comparison to local anaesthetics. Piritramide and opium solutions revealed very low pH values (3.96 and 3.38). Two patients, who underwent EOA for the last two and a half three weeks before their death showed, macroscopically and microscopically, no signs of effect on tissue. The examination of the compatibility of opiate solutions and local anaesthetics with CSF showed a deproteinisation of CSF after Piritramide and a rise of opacity after opium. Of the local anaesthetics tested, only Editocaine interferred by crystallizing of the substance. In conclusion, all opiates except piritramide and opium can be used in EOA. In our opinion bupivacaine but not editocaine can be used for spinal anesthesia. All opiates tested can be mixed either with bupivacaine or editocaine.

Anesthesia, Epidural↗
PubMed1980

[Haemodynamic, gas exchange and lung X-rays in multiple injuries with blunt chest trauma (author's transl)].

In a controlled prospective study of 50 multiple trauma patients special cardio-respiratory monitoring was performed from the moment of admission to the hospital up to seven days. We compared haemodynamic and respiratory data and roentgenograms from 34 patients with blunt thoracic trauma with those of 16 patients without thoracic trauma. The mortality of the thoracic trauma group was higher (56%) than in the control group (19%). Long term intubation was necessary in the first group for an average of 17 days and in the second group for 6.2 days. In the thoracic trauma group there was a higher total pulmonary resistance and a lower cardiac index. Despite mechanical ventilation the pulmonary gas exchange was impaired in the thoracic trauma cases, especially due to an increased shunt fraction. In 16 of the thoracic-trauma patients roentgenograms detected at least temporary pulmonary oedema simultaneously with the increase of shunt fraction and the impairment of pulmonary gas exchange of those patients.

Adolescent↗
PubMed1980

[The effects of Akrinor on the extrathoracic capacitance vessels during extracorporeal circulation and on cardiac haemodynamics of anaesthetized man (author's transl)].

The circulatory effects of Akrinor were investigated in anaesthetized patients during extracorporeal circulation and following open heart surgery. Arterial pressure, cardiac index and the maximal rate of rise of left ventricular pressure increased, whereas the resistance to flow in both circuits and the cardiac filling pressures remained unchanged. The compliance of the extrathoracic capacitance vessels during extracorporeal circulation was unaltered compared with the control group, but the volume content was less after Akrinor (200 ml). If this volume is shifted to the intrathoracic compartment in the intact circulation, the amounts seems too small to explain the increase in cardiac index. This increase and the subsequent rise of the arterial pressure seemed to be due to increased myocardial contractility.

Anesthesia↗