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Biomedical subjects

H Kaiser

Publications and source records attributed to H Kaiser.

At least 19 recordsLinked to original sources
PubMed1992

Efficacy and safety of nedocromil sodium ophthalmic solution in the treatment of seasonal allergic conjunctivitis.

To assess the efficacy and safety of twice-daily administration of nedocromil sodium 2% ophthalmic solution, we performed a multicenter study involving 140 patients with seasonal allergic conjunctivitis. Subjects had a history of seasonal allergic conjunctivitis and positive results of a skin test to ragweed. The trial coincided with the peak ragweed pollen season at five treatment centers. Patients treated with nedocromil sodium had improvements in symptoms with statistically significant reductions recorded for eye itching (P less than or equal to .04), conjunctival injection (P less than or equal to .001), and overall disease severity (P less than or equal to .001) as compared to the placebo-treated group. Adverse events were minor and transient. We concluded that nedocromil sodium 2% ophthalmic solution administered twice daily is effective in relieving major symptoms associated with seasonal allergic conjunctivitis.

Adolescent↗
PubMed1992

Plasma prilocaine and mepivacaine concentrations after combined lumbosacral plexus block.

In a pharmacokinetic study of combined sciatic/3-in-1 block for lower limb surgery, the two moderate-acting local anaesthetics prilocaine and mepivacaine were compared. The mean maximum venous plasma concentrations of mepivacaine were more than twice as high as when prilocaine was used as anaesthetic (5.1 micrograms/ml vs. 2.37 micrograms/ml). When used in combination with the former, ornipressin did not reduce plasma concentrations of mepivacaine to values which were below the threshold for toxic symptoms (5-6 mg/ml). The peak plasma concentrations exceeded the threshold of 5 micrograms/ml in four of the nine patients of the mepivacaine group (maximum value 7.21 mg/ml) and in two of the nine patients of the mepivacaine+ornipressin group (maximum value 8.61 micrograms/ml).

Adult↗
PubMed1992

Prilocaine in lumbosacral plexus block--general efficacy and comparison of nerve stimulation amplitude.

The significance of the threshold amperage of peripheral nerve stimulation (PNS) for the efficacy and latency of sciatic block is shown in a controlled randomized study of stimulation amplitude. In all cases the block was complete within a short time when the threshold amperage was 0.3 mA or less. Incomplete motor and sensory blocks occurred with higher stimulation amplitudes of 0.5 and 1.0 mA. In view of these results a prospective study of the clinical efficacy of 852 combined sciatic/3-in-1 blocks using prilocaine, and performed by means of peripheral nerve stimulation was carried out. No CNS or cardiovascular complications, no problems resulting from methaemoglobinaemia and, above all, no nervous lesions were observed. The limiting factor for surgery of the lower limb with this method of anaesthesia is the tolerance of the femoral tourniquet which depends mainly on the efficacy of the 3-in-1 block. Ninety-one per cent of the combined blockades were primarily successful when there was no tourniquet at all, and 87% when the tourniquet was placed on the lower leg. In the course of surgery with a femoral pneumatic tourniquet, only 55% of the blocks did not require supplement when 20 ml of 1% prilocaine was used for the 3-in-1 block, while 72% and 74% were efficacious with 30 ml and 35 ml, respectively. The efficacy of the sciatic block proved to be extremely high (> 95%), its success depending on the dosage of the local anaesthetic and correct execution of the peripheral nerve stimulation.

Adult↗
PubMed1992

Double-blind study of intranasal ipratropium bromide in nonallergic perennial rhinitis.

We undertook this trial to determine whether ipratropium bromide nasal spray 0.03% (IB) reduced the nasal hypersecretion associated with nonallergic perennial rhinitis (NAPR) without causing excessive dryness or irritation of the nasal mucosa. We compared two drug doses of IB (21 micrograms and 42 micrograms per nostril) to a placebo, administered as two sprays to each nostril twice daily. The study design consisted of a 1-week screening period without treatment, a 1-week single-blind placebo period, a 4-week double-blind treatment comparison period, and a 1-week follow-up period without medication to evaluate nasal rebound. One hundred fifty-two patients were entered and 140 completed the trial. Both doses of IB reduced the severity and duration of rhinorrhea compared with placebo (P = .05 and .03, respectively). Treatment differences were noticeable during the first week of therapy, continued to widen during the second week, and then remained stable throughout the next 2 weeks. There was no evidence of nasal rebound observed during the week after treatment. The drug was well tolerated with side effects limited to infrequent nasal adverse events of nasal dryness, blood-tinged mucus, and epistaxis occurring in 2% to 6% of patients. We conclude that IB is a safe and effective therapy for control of rhinorrhea associated with NAPR.

Administration, Intranasal↗
PubMed1991

[Epidural blockade for analgesia and treatment of acute pancreatitis].

The effect of a fractional epidural blockade on acute pancreatitis was investigated in a prospective study. PATIENTS AND METHODS. Thoracic (20 patients) or lumbar (six patients) epidural blockade was carried out in 26 patients with severe abdominal conditions comprising sub-ileus in 100%, pancreatic edema indicated by sonography/computer tomography in 57.8%, and necrosis of the pancreas in 34.6%. RESULTS. On average, 3.4 (1-6) injections with single doses of 6-20 ml 0.25% bupivacaine were injected per day. In four patients, morphine (up to 4 mg per 24 h) was added to the local anesthetic. The duration of treatment was between 1 and 15 days. After 10.5% of the injections, the systolic pressure decreased by more than 20%, and after 12.8% of the injections the blood pressure decreased by more than 30%. Hypotension of more than 30% was treated with 0.3 to 0.5 ml theodrenaline (Akrinor) and/or 0.1 to 0.2 mg dihydro-ergotamine (Dihydergot). General analgesics had to be administered in addition on 21.8% of the treatment days and intensive care treatment (artificial ventilation) on 32% of the treatment days. The duration of epidural analgesia varied between 1 and 15 days depending on the intensity of symptoms (pain, ileus). Within 4 days, the enzyme activity of the lipase fell from 8120 to 427 IU, and that of alpha amylase fell from 1401 to 143 IU. In 3 patients laparotomy (for drainage) was performed. An ERCP was carried out in 16 patients. Cardiopulmonary failure necessitated artificial ventilation over a period of 1-15 days in 6 patients; the epidural blockade was continued during the artificial ventilation. Cholecystectomy was carried out as an interval operation in 6 patients. No neurological complications were observed. All patients survived and were discharged from hospital.

Acute Disease↗
PubMed1991

[Dose limits for local anesthetics. Recommendations based on toxicologic and pharmacokinetic data].

Since Heinrich Braun added adrenaline to cocaine (and later also to procaine) in 1903 to allow clinical use of this local anesthetic, "limiting dosages" for local anesthetics have been "recommended" with no reference to the technique of administration, on the assumption that adrenaline will lower the toxicity of the local anesthetic used. However, the limiting dosages determined up to now do not take account of important pharmacokinetic and toxicological data: (1) The dependence of blood levels measured on the technique of regional anesthesia and (2) the raised toxicity of a local anesthetic solution containing adrenaline following inadvertent intravascular (intravenous) injection. A maximum dose recommendation that differs according to the technique of local anesthesia is suggested for (A) subcutaneous injection, (B) injection in regions of high absorption, (C) single injection (perineural, e.g. plexus), (D) protracted injection (catheter, combined techniques), (E) injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic). This sequential categorization also underscores the need for selection of appropriate techniques as well as for concomitant monitoring referred to the technique of administration and to the expected and the possible plasma level curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthetics, Local↗
PubMed1991

[Can choice of medications and adjuvants reduce risks of local anesthetic complications?].

Local anesthetic agents in high concentrations may cause local irritation by ischemia especially after the use of adrenaline whereas felypressin has no tissue-irritating properties. Adrenaline but not felypressin increases the intravenous systemic toxicity. Noradrenaline has to be avoided as a vasoconstrictor. An aspiration test before injection will decrease the risk of inadvertent intravenous injection.

Adjuvants, Anesthesia↗
PubMed1990

[Ropivacaine--a new local anesthetic with specific properties].

Ropivacaine is the (S)-enantiomer of 1-propyl-2',6'-pipecoloxylidide. In terms of its physicochemical properties, it is a long-acting local anesthetic (molecular weight of the base 274, pKa 8.07, protein-binding 92%). It shows a selective action on A delta and C fibers. This may be attributable to its relatively low partition coefficient (6.1 in n-heptane). The subcutaneous and intravenous acute toxicity (LD50) is lower than that of other long-acting local anesthetics. Because of its vasoconstrictor potency, its use as a vasoconstrictor-free solution is of particular interest.

Amides↗
PubMed1990

[Fundamentals and requirements of peripheral electric nerve stimulation. A contribution to the improvement of safety standards in regional anesthesia].

The use of a nerve stimulator allows an injection cannula to be located without the cooperation of the patient. Regional anesthesia thus becomes safer because the basic condition "no paresthesia, no anesthesia" becomes irrelevant. In accordance with the basic electrophysiological conditions, a stimulator should have the following properties: (1) adjustable constant current at resistances of 0.5-10 kOhm; (2) monophasic square-wave initial impulse; (3) impulse duration selectable (0.1 ms + 1 ms, and exactly adjustable; (4) impulse amplitude (0-5 mA) exactly adjusted, unequivocal scale graduation or current indicator, in particular in the range of 0.05-1.0 mA; (5) impulse frequency 1-2 (-3) Hz; (6) alarm at high impedance and check on electrical circuit; (7) battery test (indication of battery voltage); (8) unequivocal assignment of load end; (9) high-quality connecting cable and plug; and availability of (10) instructions for use with relevant parameters (tolerated variations, steady-state characteristic curves, etc.).

Anesthesia, Conduction↗
PubMed1990

[The function of peripheral nerve stimulators in the implementation of nerve and plexus blocks].

A selection of nine instruments supplied by eight different manufacturers for carrying out peripheral nerve stimulation were checked for their suitability, safety and ease of operation, and were compared and contrasted with reference to a spectrum of characteristics that appear desirable in theoretical and practical terms. Measurements at Ohm's resistance showed that in the clinically relevant range of impulse amplitudes (0.1-1.0 mA) the quality of adjustment of the instruments varied widely. The actual electrical impulse delivered by some of the instruments deviated so widely from the adjusted theoretical value that they must be regarded as unsuitable. The duration of the impulse corresponded to the manufacturer's specifications for only two instruments. Four instruments did not generate a monophasic square-wave signal despite assertions to the contrary in the instructions for use, and one instrument did generate such a signal although a "special biphasic asymmetrical" impulse is described by the manufacturer. Impulse-like overshooting at the beginning of the signal, oscillations into the positive range at the end of the signal and fall in current during the course of the signal were the form variants indicating technically inadequate design in the other instruments. Resistance to the square-wave current impulse engendered by the complex body resistance (impedance), a good approximation to the mathematical e-function to be expected, could be demonstrated for the rising signal flank, whereas the signal curve in the lower part of the descending flank was flatter than expected owing to polarization effects in the body tissue. The characteristic voltage and time values calculated for the signal curves are shown in tables.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1990

[Ropivacaine for peridural anesthesia. Studies on the dose-response relationship in orthopedic surgery].

In an open, nonrandomized dose response study, the efficacy of 0.75% ropivacaine (plain) for epidural analgesia was evaluated during 46 orthopedic surgical procedures (18 total hip replacements, 10 knee prostheses, 3 forefoot operations, 14 arthrotomies or osteotomies). Group 1 received 15 ml (112.5 mg); group 2 20 ml (150 mg); and group 3 25 ml (187.5 mg). The times to initial onset (6.7-7.9 min) and to the maximum level of sensory analgesia (25.7, 27.1, and 30.7 min) hardly differed. The mean maximum level of sensory analgesia increased from T6 (group 1), to T5 (group 2) and T3 (group 3), with an absolute maximum level of C3 (statistically not significant). Times for two-segment regression increased from 146 min and 169 to 192 min, for regression of analgesia to T10 from 193 and 189 to 246 min and to T12 from 220 min and 244 to 296 min (significant). The mean maximum durations were 239(+/- 54), 267(+/- 49.8) and 355(+/- 59.2) min. The degree of motor blockade varied with the volume. Motor block grade I was recorded in 100% of cases, and motor block grade II in 64% of patients in group 1, in 73% in group 2, and in 100% in group 3. Motor block grade III was only seen in 7.1% in group 1, 20% in group 2, and 47% in group 3. The duration was 102 min, 133 min and 188 min for grade I, 158 min, 199 min and 263 min for grade III when this occurred. MAP, HF and RPP varied by a maximum of -8.3%, -11.5% and -17.6% from the initial value.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗