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Biomedical subjects

H Kaiser

Publications and source records attributed to H Kaiser.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1989

[The single intercostal block--surgical and therapeutic indications].

Since the first paravertebral blockade was carried out by Sellheim in 1905, this method has proved effective for the isolated blockade of spinal nerves. The efficacy of preoperative intercostal blockade (ICB) in combination with neuroleptanalgesia (NLA) or Pentothal-pentazocine-N2O anesthesia (Pe-Pz) was studied (unilateral analgesia for cholecystectomy). Group 1: NLA; group 2: NLA with ICB; group 3: Pe-Pz; group 4: Pe-Pz with ICB. The analgesic requirement differed significantly between groups 1 (0.33 mg fentanyl) and 2 (0.15 mg fentanyl) and groups 3 (63.5 mg pentazocine) and 4 (31.5 mg pentazocine). There were also significant differences in circulatory responses. The maximum deviation from the initial value at the beginning of the operation in group 1 compared to group 2 was pulse rate + 28.7% vs + 2.4%, mean arterial pressure (Part) + 24.6% vs + 3.1%, and systolic pressure (Psyst) + 33% vs +/- 0%; group 3 compared to group 4: pulse rate + 16.4% vs + 3.2%, Part + 24.5% vs 0.0%, and Psyst + 26.5% vs + 196. The times of action of ICB extended from 7.54 h to 11.33 h for partial analgeisa, time to the first dose of analgesic from 12.3 h to 16.9 h (etidocaine 0.5% and 1% respectively without and with epinephrine). The mean blood levels after 100 mg bupivacaine-CO2 rose to 1.16 micrograms/ml after 5 min and reached a maximum after 15 min (1.29 micrograms/ml) as compared to 0.98 micrograms/ml after addition of ornithine-vasopressin. These values are very much higher than those after the use of bupivacaine-HCl solution. Etidocaine and bupivacaine-HCl have comparable durations of analgesia. Toxicologically, both substances can be applied safely with consideration of all pharmacological data for ICB. Of a total of 3,485 intercostal blockades, 2,775 were applied perioperatively (pre- and postoperatively); 265 were carried out for trauma patients (rib fractures) and 445 for therapeutic indications (herpes zoster neuralgia, tumor pain, costovertebral pain). In 8 blocks 10% ammonium sulfate, in 4 blocks absolute alcohol, and in 19 blocks 5% phenol were used for neurolysis. In 2 cases a marginal pneumothorax was seen, which was resorbed spontaneously (0.06%). Altogether 16,270 single intercostal nerves were blocked. Single-session intercostal blockade can be combined as unilateral analgesia with general anesthesia. This combination is characterized by stable circulatory conditions with avoidance of hypertensive reactions. The long-lasting analgesia allows early mobilization and physiotherapy both postoperatively and posttraumatically in patients with unilateral thoracic and abdominal pain.(ABSTRACT TRUNCATED AT 400 WORDS)

Bupivacaine↗
PubMed1988

Cytomegalovirus infection after autologous bone marrow transplantation with comparison to infection after allogeneic bone marrow transplantation.

Cytomegalovirus (CMV) infection was detected in 65 of 143 (45%) autologous bone marrow transplant (BMT) patients. CMV pneumonitis occurred in only 2% of the patients and CMV retinitis occurred in none. Infection occurred in half of the 40 initially seronegative patients and 47% of the 94 initially seropositive patients. Among initially seropositive patients, platelet recovery was slower in infected patients than in those not infected (97 v 35 days median, P = .003), and neutrophil recovery was slightly delayed in infected patients (31 days v 24 days, P = .02). Although the incidence of CMV infection was comparable in autologous and allogeneic BMT patients, CMV pneumonitis was less frequent in autologous BMT patients (2% v 12%, P less than .001). The risk for CMV pneumonitis in autologous BMT patients was comparable with that in allogeneic BMT patients without graft-v-host disease (GVHD) (2% v 6%), but significantly lower than the risk in allogeneic BMT patients with GVHD (2% v 23%, P less than .001).

Bone Marrow Transplantation↗
PubMed1988

[Evaluation of the prevention of perioperative thromboembolism with low molecular weight heparin and dihydroergotamine. A study of the incidence of lethal pulmonary embolisms and undesired symptoms, especially the risk of vasospasm and myocardial infarction].

In a prospective trial 33,421 patients receiving a combination of low molecular weight heparin and dihydroergotamine (LMWH/DHE; Embolex NM) as a routine antithrombotic agent were observed. The patients were recruited from surgical, traumatological, orthopedic, gynecological and urological departments. During the observation period 17 patients suffered from myocardial infarction leading to death in 7 cases. In 63 patients pulmonary embolism occurred, causing death in 12 cases. No irreversible vasospastic reaction due to DHE was seen. In one case a reversible ischaemic reaction in a lower limb was described which might have possibly been due to DHE. The low rate of complications suggests that LMWH/DHE is a safe and highly effective combination with a low risk of vasospastic reactions.

Coronary Disease↗