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Biomedical subjects

H Nolte

Publications and source records attributed to H Nolte.

At least 55 records · Page 3Linked to original sources
PubMed1991

Suppressive effect of loratadine on allergen-induced histamine release in the nose.

It has been speculated whether the recently developed non-sedating antihistamines may possess other properties than merely being antagonists at the H1-receptors. To investigate this suggestion 12 patients with strictly seasonal allergic rhinitis participated in a double-blind placebo controlled randomized cross-over study outside the pollen season. At steady state levels of 10 mg loratadine, a new non-sedating antihistamine, the patients were challenged with methacholine. This was followed by a nasal challenge with increasing doses of allergen. 24 h later the patients were rechallenged nasally with the same methacholine dose as the day before. The volume of the methacholine-induced nasal secretion was measured and the response to allergen was determined by scoring technique. In returned nasal lavage fluid the levels of histamine and TAME-esterase activity were measured. It was found that loratadine significantly reduced the immediate allergic nasal symptoms compared with placebo (P less than 0.01). Loratadine also reduced the allergen-induced release of histamine into the nasal cavity after the strongest allergen dose, from 9.6 +/- 1.5 (mean +/- SEM) to 6.4 +/- 1.4 ng/ml (P less than 0.05). A similar decrease in the TAME-esterase activity after treatment with loratadine was observed. The TAME-esterase activity decreased from 11.6 *10(3) +/- 2.47 *10(3) to 5.60 *10(3) +/- 1.45 *10(3) CMP (P less than 0.05). There were no significant changes between the active and placebo treatments regarding the methacholine-induced secretory response. This was true for the initial methacholine challenge as well as the secretory response 24 h later.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[An attempt at a mathematical prediction of the depth of insertion of the needle in peridural anesthesia].

The purpose of the investigation was to correlate the distance from the skin to the flaval ligament with the individual data of patients such as bodyweight, height, sex and age with the aim of predicting the depth of insertion of the needle. In a retrospective study we examined 448 patients (217 men and 231 women). In the anaesthetic records the depth of insertion of the needle was noted together with the patients' personal data. Evaluation of the material showed that there is no correlation of statistically significant relevance between the depth of insertion and the bodyweight and age of the patient, but there is a correlation between depth of insertion on the one hand and the variables bodyweight, overweight and the quotient body height/weight on the other. This correlation showed a somewhat higher significance in women than in men. The correlation can be expressed in a formula like y = K + fx, whereby for the relation between depth of insertion and body weight the equation for men is y = 1.87518 + 0.02761x. The equation for women is y = 2.23985 + 0.03559x. With these formulae a rough prediction for the depth of insertion can be made, with x representing the bodyweight and y the expected depth in cm. The measured values fluctuated between 3.5 and 7.4 cm in the 217 men, with the medium value at 4.08 cm. In the 231 women the measured values fluctuated between 3.3 and 6.9 cm with the medium value at 4.67 cm.

Adolescent↗
PubMed1990

Immunochemical cross-reactivity between albumin and solid-phase adsorbed histamine.

For production of an antibody against histamine, this was coupled to human serum albumin (HSA) and used for immunization of rabbits. To test the antiserum, an immunoradiometric assay was developed comprising solid-phase bound histamine, antisera and radiolabelled protein A. Titration and inhibition experiments revealed that histamine adsorbed onto a solid-phase could bind the antiserum. However, neither free histamine nor histamine coupled to unrelated carriers could inhibit the binding of antiserum to the solid-phase histamine. Cross-reactivity was demonstrated between HSA and solid-phase bound histamine, as the immunoradiometric assay was inhibited by HSA. This unexpected cross-reactivity was established, as a commercially available antiserum with specificity to HSA without histamine also bound to the solid-phase bound histamine. It is suggested that preparations of antibodies against histamine are tested for this possible cross-reactivity.

Adsorption↗
PubMed1990

Measurement of histamine in nasal lavage fluid: comparison of a glass fiber-based fluorometric method with two radioimmunoassays.

The determination of histamine in nasal secretions and nasal lavage fluid may be of importance to monitor activation of histamine containing cells in the nasal cavity. However, such studies have been besieged by controversy, specifically to findings of changes in histamine levels in relation to allergenic stimulation. This controversy may be due to the specificity and accuracy of the various methods used to determine histamine in the nasal fluid. We have therefore applied and compared three new methods to determine histamine in nasal lavage fluids obtained before and after allergen challenge in normal subjects and patients with allergic rhinitis. We used a fluorometric glass fiber-based histamine method (FHR) and two RIAs, I and II. The FHR (detection limit, 7.0 nmol) and the RIA II (detection limit, 0.2 nmol) are specific for histamine itself, whereas the RIA I (detection limit, 18.0 nmol) measures mainly methylhistamine and cross-reacts to some extent with histamine. The histamine levels in the nasal lavage fluids from the nasal challenges demonstrated histamine values between 100 and 2000 nmol/L of histamine with significantly higher levels in the postallergen challenges for the allergic subjects as compared to the normal control subjects. The FHR correlated well with the RIA I and RIA II methods with correlation coefficients of 0.77 to 0.88 (p less than 0.001), respectively. However, the RIA I (methylhistamine antibody) always demonstrated absolute histamine values 5% to 20% of values measured by the RIA II (at the level of cross-reactivity to histamine).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Diagnostic value of a glass fibre-based histamine analysis for allergy testing in children.

The aim of this study was to compare the diagnostic value of common allergy tests with basophil histamine release in 124 children with symptoms of asthma. The patients were evaluated by case history, skin prick test, RAST-analysis, and basophil histamine release using a glass fibre-based histamine assay to 10 common inhalant allergens. The bronchial provocation test was used as a reference of "true" IgE-mediated asthma. To compare the various diagnostic parameters each absolute test value was classified into a scoring system. The concordance between the tests varied between 85-97%. In general, the best concordance was found between basophil histamine release and RAST. Sensitivity, specificity and predictive values were calculated on the basis of 104 bronchial provocation tests. It was found that histamine release was the best single analysis, followed by RAST and prick testing. The sensitivity of RAST and histamine release was very high (1.00) for pollen and house dust mites. Histamine release showed a predictive value between 0.91 and 1.00 for pollen and house dust mites, thus indicating the possibility of omitting the bronchial provocation test. In the dander group histamine release gave the best sensitivity (0.91), however at the expense of specificity (0.64), whereas RAST and skin prick test gave a specificity of 1.00. In the mould group histamine release also showed the best diagnostic value. The combination of skin testing with histamine release or RAST was of no additional diagnostic help. It is concluded that the glass fibre-based histamine analysis, which makes routine histamine release testing possible, is a reliable diagnostic test in children.

Asthma↗
PubMed1990

Basophil histamine release in the diagnosis of house dust mite and dander allergy of asthmatic children. Comparison between prick test, RAST, basophil histamine release and bronchial provocation.

The aim of the study is to compare the glass fibre-based basophil histamine release test with skin test (Phazet), RAST (Phadebas) and bronchial provocation test in children with allergic asthma. The study comprised 68 selected children with a case history of extrinsic allergic asthma to danders (cat and dog) and house-dust mite. Skin prick test, RAST, and histamine release were performed in all children and the bronchial provocation test was used as a reference of "true allergic asthma". A total of 81 allergen bronchial challenges were performed and 44 children experienced 49 positive provocations. In 2.9% (2/68) of the children histamine release could not be performed due to technical difficulties (low histamine release with anti-IgE). Concordances in the range 76-87% were observed with no significant difference between the tests. The highest concordance (87%) was found between histamine release and bronchial provocation test followed by skin prick test vs bronchial provocation (84%) and RAST vs bronchial provocation (80%). The sensitivity and specificity were calculated for each test. All tests showed sensitivities in the range 90-94% and no significant difference between them was observed. The specificity of histamine release, skin prick test, and RAST was 0.78, 0.69, and 0.63, respectively. The specificity of histamine release was better than RAST demonstrated by 95% confidence intervals. In conclusion, it was found that the histamine release test is a convenient diagnostic method and the study indicates a diagnostic value comparable to the common diagnostic methods in clinical allergy.

Animals↗
PubMed1990

Passive sensitization and histamine release of basophils. IgE and cellular factors regulating histamine release.

This study had two purposes. First, to examine a possible functional heterogeneity of IgE regulating basophil histamine release and the effect of using two different donor cells for passive sensitization experiments. Second, to investigate basophils not releasing histamine to anti-IgE by stimulating protein kinase C with the addition of the phorbol-ester, TPA. In consecutive experiments responding donor basophils were passively sensitized with plasma from non-responding subjects. Thus, the first set of experiments included passive sensitization of acid treated donor basophils from one atopic and one non-atopic patient with plasma from 29 children with exogenous asthma to grass pollen, cat dander, or dust mites. Different secretagogues (anti-IgE, Concanavalin A, and N-formyl-methionyl-leucyl-phenylalanine) induced different histamine release responses due to a cellular property of the basophils not related to the type of IgE bound to the cell membrane. It was demonstrated that the allergen-induced histamine release did not depend on the extract or type of IgE when the biological activity of each extract and serum-specific IgE levels were similar. However, the atopic donor cells released significantly (P less than 0.05) more histamine than non-atopic donor cells. Thus, histamine release depends on the type of secretagogues and a cellular property which is maybe influenced by the presence of serum factors and a certain type of IgE in the serum of atopics. The second set of experiments included 10 patients (6 atopics and 4 non-atopics) with non-histamine releasing basophils. In the presence of 10 ng/ml TPA, however, seven of 10 patients released histamine at anti-IgE challenge. Three months later two additional patients became responsive in the presence of TPA. By passive sensitization of responding donor basophils the non-responding patients were shown to possess functionally intact IgE. Thus, the discrepancies sometimes observed between clinical symptoms, serological IgE-antibody measurements and histamine release testing in allergic patients may be related to a cellular property of basophils.

Adolescent↗
PubMed1990

Histamine release from gut mast cells from patients with inflammatory bowel diseases.

Inflammatory mediators from intestinal mast cells may serve as initiators of acute and delayed inflammation. Mast cell histamine release was measured in 19 patients with inflammatory bowel diseases using gut mast cells from enzymatically dispersed endoscopic forceps biopsy specimens of macroscopically inflamed and normal tissue. Mast cells and corresponding basophils were challenged with anti-IgE, anti-IgG, subclass anti-IgG4, and formyl-methionyl-leucyl-phenylalanine (FMLP) and results were compared with those from nine patient control subjects. The mast cell count in patients with ulcerative colitis was increased compared with that in control subjects and patients with Crohn's disease, and the mast cell count obtained from inflamed tissue was greater than that of normal tissue. The study also shows the heterogeneity of the responsiveness of the histamine releasing cells to various secretagogues. Thus, mast cells released 0.4 (0.0-2.0) (median (range)) ng histamine per sample at anti-IgE challenge, and basophils were also anti-IgE responsive. In contrast, mast cells did not respond to FMLP but the corresponding basophils did. Gut mast cells released 0.3 (0.0-1.0) (median (range)) ng histamine per sample at anti-IgG4 challenge; however, the corresponding basophils did not respond to anti-IgG4. In addition, the anti-IgG4 mediated histamine release was primarily confined to patients with inflammatory bowel disease. This study substantiates previous histopathological findings that mast cells may play a functional role in the inflammatory process of inflammatory bowel diseases and provides evidence for a possible role of subclass IgG4 as a reaginic antibody.

Adolescent↗
PubMed1990

Histamine release from skin mast cells and basophils in patients with urticaria pigmentosa.

Histamine release from dispersed skin mast cells may be used for functional studies on the mast cell. However, technical difficulties have hampered such studies. In the present study a new fiberglass-based histamine assay was applied to previously described dispersion techniques, using excision biopsies from 7 patients with urticaria pigmentosa, 3 with psoriasis as well as 4 with urticaria. However, sufficient mast cell numbers for performing histamine release could only be obtained from patients with urticaria pigmentosa. The average mast cell yield was 935 +/- 470 cells (mean +/- SD) per mg wet weight of tissue. The skin mast cells from these patients responded with dose-dependent histamine release to anti-IgE, calcium ionophore A23187, and N-formyl-methionyl-leucyl-phenylalanine challenge without previous passive sensitization. The pattern of histamine release of mast cells and corresponding blood basophils did not indicate substantial differences between the two cell types.

Basophils↗
PubMed1990

[The equipotency of ropivacaine, bupivacaine and etidocaine].

Ropivacaine, congenerate to bupivacaine and mepivacaine has been widely studied in laboratory animals, but there have been few investigations of its efficacy in human epidural anesthesia and peripheral nerve blocks. The aim of this study was to compare the three long-acting local anesthetics (bupivacaine 0.75%, ropivacaine 1% and etidocaine 1%) and to try, with reference to previous studies, to make some statement about the equipotency of ropivacaine relative to bupivacaine and etidocaine. METHODS. In a double blind randomized study, epidural anesthesia was carried out with 20 ml bupivacaine 0.75% (n = 24) and ropivacaine 1% (n = 21). Following this study epidural anesthesia was carried out with 20 ml etidocaine 1% (n = 20) in an open study. Patients with ASA I or II were enrolled in the study. All patients were scheduled for varicose vein stripping. Male and female patients aged 18-70 years and weighing 50-100 kg were included in the study. Patients were all placed in a sitting position, after which the epidural space was identified by the "loss of resistance" technique and a midline approach, at the L-3/4 interspace. Injections of 3 ml of the local anesthetic were given, followed by the remainder of the local anesthetic at 10 ml/min 1 min later. Following injection patients were immediately positioned supine. Analgesia was determined by the pin-prick method and motor blockade was assessed according to the Bromage scale. Heart rate and blood pressure were monitored until 3 h after injection. RESULTS. The latency of analgesia for the first blocked segment (T 12 for bupivacaine and ropivacaine and L-1 for etidocaine) was 6.0 min for bupivacaine 0.75, 5.5 min for ropivacaine 1%, and 5.2 min for etidocaine 1%, and the highest thoracic dermatome (T 5 for bupivacaine, T 4 for ropivacaine and T 7 for etidocaine) was reached after 24 +/- 10, 26 +/- 9, and 30 +/- 18 min for bupivacaine, ropivacaine, and etidocaine, respectively. The duration of sensory anesthesia at the T 10 dermatomal level was 257 +/- 102, 278 +/- 67, and 191 +/- 86 min for bupivacaine, ropivacaine, and etidocaine, respectively. The two-segment regression time was 199 +/- 80 min for bupivacaine, 201 +/- 52 min for ropivacaine, and 174 +/- 81 min for etidocaine. The total duration of sensory block was 340 +/- 103 min for bupivacaine, 428 +/- 65 min for ropivacaine and 223 +/- 62 min for etidocaine, respectively. In the ropivacaine and bupivacaine groups sensory anesthesia was considered adequate for surgery in all cases but one in each group; in the etidocaine group, however 60% of the patients showed inadequate analgesia and all these patients (12/20) required additional analgesics. Bupivacaine achieved an average of motor block 2.1, ropivacaine 2.3, and etidocaine 2.4. CONCLUSION. The results of this study indicate that ropivacaine is an effective local anesthetic agent. Its potency is about equal to that of bupivacaine and much higher than that of etidocaine...

Acetanilides↗
PubMed1990

[The effect of injection speed and needle gauge on the spread of sensory blockade in spinal anesthesia].

Unanimity has not yet been reached on the influence of injection speed and needle size on the spread of sensory blockade in spinal anesthesia. While McClure et al. [6] proved that a change in injection speed had no effect on the spread of the blockade, Lanz et al. [4] showed in their investigation that increasing injection speed increases the spread of the blockade. The influence of needle size has hardly been investigated so far. Moore et al. [7] report that the needle size alone has no effect on the spread of the blockade. In this study the influence of injection speed and that of needle size on spread of sensory blockade were considered separately. MATERIALS AND METHODS. Spinal puncture was performed via the midline approach at the L3-4 interspace with the patient in a sitting position. Immediately after the induction of anesthesia the patients were placed in the supine position again. As local anesthetic 15 mg (3 ml) bupivacaine 0.5% with epinephrine 1:200000 was administered. The aim of the study was to find out how far injection speed and size of the spinal needle influenced the sensory spread in isobaric spinal anesthesia. The height of sensory blockade was assessed by means of the pin-prick method in the midline, and the onset of analgesia was determined as height of spread. The injection speeds for the local anesthetic solution were 0.25, 0.5 and 1 ml per second. The needle sizes were 22, 25, and 29 gauge. Each group consisted of 15 patients. RESULTS. It turned out that slow (0.25 ml/s) and the fast (1 ml s) injection was associated with a significantly higher level of analgesia than the medium one (0.5 ml/s). Cephalad spread was to T7 in the first two groups, while the medium injection speed only achieved a level of T9. The results are statistically significant (P less than 0.05). The comparison of different needle sizes (22, 25, and 29 gauge) used for spinal anesthesia showed a higher spread of the sensory blockade with increased diameter of the spinal needle given a constant injection speed. With the 22-gauge needles (n = 15) sensory blockade extended on average to T7, with 25-gauge needles (n = 15) to T9, and with 29-gauge needles (n = 15) to T10. It has to be mentioned, however, that with the 29-gauge needle the standard injection speed of 0.5 ml/s could not be achieved because of the small inner diameter. The differences between 22- and 25-gauge needles are statistically significant (P less than 0.05). DISCUSSION. No direct relation could be proved between the different injection speeds and the spread of the blockade. Our results are hardly comparable with those of other investigators, since other groups have used different local anesthetics or performed investigations in vitro. The use of large spinal needles is associated with spread of the spinal block to a significantly higher level than is achieved with thinner needles.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1990

[The effect of volume and dosage of isobaric bupivacaine on the sensory spread of spinal anesthesia].

There is some controversy about the relationship of volume, concentration and total dose of bupivacaine in the sensory spread of spinal anesthesia. In this study the effects of volume and dose were investigated. MATERIAL AND METHODS. In this study 120 patients undergoing lower extremity, inguinal or transurethral surgery were randomly divided into six groups. Bupivacaine 15 mg with the addition of epinephrine 1:200,000 was administered in 2 ml (0.75%), 3 ml (0.5%), 6 ml (0.25%) and 9 ml (0.166%) solutions. In addition 3 ml isobaric bupivacaine in doses of 7.5 mg (0.25%), 15 mg (0.5%) and 22.5 mg (0.75%). The spinal puncture was performed via the midline approach at the L3-4 interspace, with the patient in the sitting position. The injection speed was 0.5 ml per second. Immediately after the injection the patients were placed in the supine position. The spread of sensory blockade was assessed by means of the pin-prick method in the midline. Motor blockade was assessed on the Bromage scale 0-3. RESULTS. There were no statistically significant differences in motor blockade or cardiovascular changes. The maximum cephalad spread of analgesia (30 min) between the 15 mg groups with different volumes and concentration was: group I (9 ml): T7.7, group II (6 ml): T7.8, group III (3 ml): T8.5 and group IV (2 ml): T10.1. The differences between group IV 2 ml and the groups receiving 3, 6 and 9 ml were statistically significant (P less than 0.05). There were no statistically significant differences in maximum cephalad spread between the 7.5 mg (3 ml), 15 mg (3 ml) and the 22.5 mg (3 ml) groups. The regression after 180 min was significantly shorter in the 7.5 mg group than in the 15 mg and 22.5 mg groups (P less than 0.05). DISCUSSION. Earlier published results indicate that the dose of isobaric bupivacaine is more important in spinal anesthesia than the concentration or the volume of the solution. The comparison between 3 ml:6 ml and 3 ml:9 ml bupivacaine showed no statistically significant differences in cephalad spread. A volume-dependent increase in segmental spread was between the 2 ml (0.75%) and 3 ml (0.5%) bupivacaine. The same statistically significant differences were between the 2 ml and 6 ml groups and the 2 ml and 9 ml groups. No statistically significant difference in cephalad spread resulted from increasing the dose of bupivacaine from 7.5 mg to 22.5 mg. Earlier studies on the effects of changes in volume, concentration and dose of bupivacaine showed similar "jumps of blockade" between 2 ml and 3 ml injected volume. Assembling the results the relation between volume and total dose does not suggest a no linear dependence. The anatomic configuration of the spinal cord at the conus medullaris may affect the distribution of the solution.

Adult↗
PubMed1990

[The effect of patient positioning on the spread of sensory blockade in hyperbaric and isobaric spinal anesthesia using bupivacaine].

Two prospective studies were performed to assess for how long after the subarachnoid injection of local anesthetics changes in position influence the cephalad spread of sensory blockade. Divergent accounts have been given by other groups. Besides the patient's position other factors may influence the cephalad spread of sensory blockade such as baricity of local anesthetics, speed of injection, dose, volume, barbotage and size of needle. Pashalidou found that after a supine position for 5 or 10 min, followed by Trendelenburg position for 5 or 10 min, there were significant differences in the increase of sensory blockade; the following two prospective studies were carried out with this in mind. METHODS AND MATERIAL. Study 1. Injection of the local anesthetics in sitting position, puncture at L3/4 interspace using a 25-gauge needle, speed of injection 3 ml/10 s, without barbotage. After injection the patients were supine for 30 min, then changing to the Trendelenburg position (n = 20) or the lithotomy position (n = 20), each for 20 min. The spread of blockade was tested by means of pin-pricks in the midline at 5-min intervals. Local anesthetics used were bupivacaine 0.5% with adrenaline (1:200,000) (n = 20) and bupivacaine 0.5% in 8% glucose (n = 20), 3 ml each. Study 2. Intrathecal injection was done as described above, but the speed of injection was 3 ml/6 s. Local anesthetics used were bupivacaine 0.5% with adrenalin (1:200,000) and bupivacaine 0.5% with adrenalin (1:200,000) in 5% glucose, 3 ml each. The patients were kept supine for either 15 or 20 min followed by 20 degrees Trendelenburg position for 10 min. RESULTS. Study 1. The mean spread of sensory blockade with isobaric bupivacaine was 16.95 segments (T6). After the 20 degrees Trendelenburg position the spread of blockade increased by 0.85 segments. After the lithotomy position there was no increase in sensory blockade. With hyperbaric bupivacaine the mean spread of sensory blockade after 30 min in the supine position was 17.3 segments (T5/6). After the Trendelenburg position there was no increase in sensory blockade. After the lithotomy position the sensory blockade spread by 0.4 more segments. This shows that there is no significant increase of cephalad spread of sensory blockade with either isobaric or hyperbaric bupivacaine. Study 2. With isobaric bupivacaine the mean spread of sensory blockade (n = 15) after 15 min in the supine position was 14.4 segments (T8/9). Following the Trendelenburg position the caphalad spread was increased by 0.93 segments (p less than 0.05). With hyperbaric bupivacaine the mean spread of sensory blockade (n = 15) was 16 segments (T7). Following the Trendelenburg position the spread was extended by 2.0 segments (p less than 0.05). After 20 min in the supine position following isobaric bupivacaine the mean spread of the sensory blockade (n = 15) was 15.4 segments (T7/8).(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1990

[The effect of barbotage on the sensory spread in spinal anesthesia using isobaric and hyperbaric 0.5% bupivacaine].

The effect of spinal anesthesia with barbotage versus without barbotage on the spread of analgesia was investigated. For comparison, hyper- and isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used. MATERIAL AND METHODS. Barbotage was accomplished as follows: after lumbar puncture 0.5 ml CSF was aspirated into the local anesthetic solution, followed by reinjection of 1.0 ml of the solution. This process was repeated six times. Sixty patients who were scheduled for urological or lower limb surgery under spinal anesthesia were selected for this study. Patients were each arbitrarily assigned to one of four groups (isobaric and hyperbaric, without and with barbotage). RESULTS. There was no statistically significant difference in the maximum level of sensory analgesia. The mean maximum level of sensory analgesia reached T9 (group 1), T8 (group 2), T9 (group 3) and T8 (group 4). Time to highest dermatome was significantly shorter with barbotage (groups 1-4: 19.0 min, 13.0 min, 18.7 min, 12.3 min). Times for regression of analgesia to T12 (mean maximum duration) were 142 (+/- 54.9) min, 164 (+/- 29.7) min, 130 (+/- 40.4) min and 144 (+/- 36.2) min (groups 1-4). Motor block grade 3 (Bromage) was achieved in significantly shorter times with barbotage than without. The shortest onset time was recorded with isobaric bupivacaine. The onset time of a complete motor block was 12.5 (+/- 5.5) min in group 1, 6.1 (+/- 2.9) min in group 2, 15.8 (+/- 4.7) min in group 3, and 11.7 (+/- 5.1) min in group 4. CONCLUSIONS. The results showed no significant differences between the maximum segmental sensory levels or duration of anesthesia observed with isobaric and with hyperbaric bupivacaine (with and without barbotage). Sufficient analgesia was obtained with barbotage and without barbotage. Uncontrolled cephalad spread of spinal anesthesia was not observed. Barbotage has the advantage of shortening time for spread to highest dermatome and the time to onset of complete motor block.

Aged↗
PubMed1990

[The concentration of free lidocaine in arterial, central venous and peripheral vein plasma following intravenous injection].

Ten intensive care patients and five healthy volunteers each received a bolus injection of lidocaine HCl (100 mg, 2%) over an injection period of 5 s. After 0.5, 1, 2, 4, 8, 15 and 25 min arterial, central venous and peripheral venous blood samples were collected. In four of the volunteers, arterial and central venous samples were also taken about 10 s after the end of injection. The fluorescence polarization method by means of the Abbott-TDx system was used, and plasma concentrations of lidocaine were determined. The measurements showed that lidocaine levels in central venous plasma 10 s after the end of administration were higher than those in arterial plasma. By 30 s after administration the opposite situation had developed, so that arterial concentrations were higher than those in central venous plasma. This relation did not change throughout the study, though the two levels became closer, as is shown by the ratios (Table 3, Fig. 2). Concentrations in peripheral venous plasma increased more slowly but remained far below those in arterial and central venous plasma, at least for the first 8 min. After 15 min lidocaine levels were almost the same in all three samples. During the entire study there were no ECG changes, and neither heart rate nor blood pressure showed any significant deviation from the values obtained at the beginning. The volunteers had minor toxic manifestations, such as dizziness, tinnitus and a metallic taste in the mouth; one person had a sensation of pressure in his chest, which improved following oxygen administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Ropivacaine in epidural anesthesia. Dose-response relationship and a comparison with bupivacaine].

UNLABELLED: Ropivacaine is a new long-acting local anesthetic with a pharmacodynamic profile resembling that of bupivacaine; in addition, ropivacaine has been shown to be less cardiotoxic than bupivacaine in dogs and pigs. To test the dose-response relationship of ropivacaine 0.75% (epinephrine 1:200,000) given epidurally, 47 patients were divided into three groups; the first group received 15 ml (n = 16), the second 20 ml (n = 15), and the third group, 25 ml (n = 16) ropivacaine. Further, to compare bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% for epidural anesthesia, 15 ml bupivacaine 0.75% (n = 15) or bupivacaine 0.5% (n = 15) or ropivacaine 0.75% (n = 16) was given epidurally, all with epinephrine added to the solution (1:200,000). METHODS: A total of 77 patients with ASA I or II were enrolled in a non-randomized open-label study. All patients were scheduled for varicose vein stripping. Male and female patients aged 18-70 and weighing 50-100 kg were included in the study. Patients were all placed in a sitting position and the epidural space was identified by the "loss of resistance" technique using a midline approach at the L 3/4 interspace; a test dose of 3 ml local anesthetic was then given, followed by injection of the remainder of the local anesthetic at the rate of 10 ml/min 1 min later. Following injection patients were immediately positioned supine. Upward and downward spread of analgesia were determined bilaterally by the pin-prick method, motor blockade was assessed by use of the Bromage scale following each determination of analgesia. Heart rate and blood pressure were obtained immediately before blockade and every 5 min until 3 h after the injection. RESULTS. The different volumes of ropivacaine 0.75% (15, 20, and 25 ml) brought about adequate analgesia in the sacral and lumbar regions in all patients. In the thoracic region T 6, T 5 and T 4 were reached. The time of onset of analgesia (segment L-1 in all three groups) was 6.4 +/- 2.9 min, 7.7 +/- 2.3 min, and 5.6 +/- 2.9 min for the 15-, 20- and 25-ml groups, respectively. The highest thoracic dermatome was reached after 20 +/- 6 min, 26 +/- 11 min, and 18 +/- 5 min. The duration of sensory anesthesia at the T 10 dermatomal level was 250 +/- 68, 249 +/- 77, and 278 +/- 51 min. Two-segment regression time was 160 +/- 67 min for bupivacaine 0.75%, 140 +/- 60 min for bupivacaine 0.5%, and 124 +/- 29 min for ropivacaine 0.75%. The total duration of sensory block was 303 +/- 58, 290 +/- 70, and 343 +/- 55 min for 15-, 20- and 25-ml groups, respectively. The degree of motor block achieved was 1.6, 1.8, and 2.0 (Bromage), respectively. Sensory anesthesia was considered adequate for surgery in all patients, and no signs of systemic toxicity were observed in any of the patients. The comparison of bupivacaine 0.75%, bupivacaine 0.5% and ropivacaine 0.75% revealed the same latency period of analgesia for bupivacaine 0.75% and ropivacaine 0.75%. This was shorter than for bupivacaine 0.5% (bupivacaine 0.75%: 6.4 +/- 2.1, bupivacaine 0.5%: 7.8 +/- 4...

Adult↗