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Biomedical subjects

H Nolte

Publications and source records attributed to H Nolte.

At least 91 records · Page 5Linked to original sources
PubMed1986

[The problem of the cardiotoxicity of bupivacaine 0.75%].

A survey of American publications on the problem of cardiotoxicity of bupivacaine 0.75% is given. It can easily be demonstrated that all investigations were done on animals. Furthermore the dosages used in these investigations are far above those which are applied in humans. It seems to be rather obvious that with increasing emotional discussions of the problem of bupivacaine 0.75% the conclusions of the investigators are becoming more and more "defensive". Even the same group of investigators who dealt with the problem previously explain their results more cautiously 3 or 4 years later! Besides these investigations some of the more positive publications of the last 2 or 3 years are discussed. Finally it is pointed out that all clinical or experimental investigations on humans did not show any negative results when bupivacaine 0.75% was used. Careful application and a dose of not more than 2 mg per kg body weight are mandatory. With this in mind there seems to be no justified reasons to withdraw bupivacaine 0.75% from the market. Finally recommendations for correct application of bupivacaine 0.75% for epidural anaesthesia in obstetrics and surgery are given.

Anesthesia, Epidural↗
PubMed1986

[Bupivacaine 0.5% and 0.75% for peridural anesthesia in operations on the extremities].

The safety of bupivacaine in respect of its cardiotoxicity has been discussed recently. Especially the concentration of bupivacaine 0.75% has been heavily criticized, first of all in obstetrical anaesthesia. Therefore two groups of patients receiving bupivacaine 0.5% and bupivacaine 0.75% were compared according to complications and side effects related to the local anaesthetic. 749 patients undergoing varicose vein stripping were divided in two groups: 371 patients received bupivacaine 0.5% with adrenalin 1:200,000 and 378 patients bupivacaine 0.75% with POR-8 (0.1 i.U./ml) for epidural anaesthesia. The average age was 46 years (20-71 y.). The average height 168 cm (149-196 cm), and the average weight 72 kg (40-99 kg). There were 68.7% female and 31.3% male patients in these groups. The anaesthesia charts of these patients were evaluated retrospectively. The incidence of hypotension, breadycardia, tachycardia, extrasystoles, vomiting and muscle twirching were taken as side effects. The two groups were compared. The results showed in relation to age, risk-grouping and the dosage/kg no evidence of an increased cardiotoxicity of the higher concentration of bupivacaine. Thus bupivacaine 0.75% does not show any increase in complications or side effects as long as its application is done correctly.

Adult↗
PubMed1986

[Monitoring of cardiac output during use of bupivacaine 0.75% by ventriculography (99mTC)].

Fifteen patients undergoing orthopaedic surgery on the lower limbs were give continuous epidural anaesthesia with bupivacaine 0.75%. It was looked after changes in heart frequency, beat volume and changes in heart rhythm. Changes in cardiac output were investigated by ventriculography with 99mTC during 4 periods--10 min before and 10, 20 and 30 min after epidural blockade--the cardiac output was measured by a computer mathematically. Each patient received 2 mg/kg body weight of bupivacaine 0.75%. Besides the observation of blood pressure, heart rate and electrocardiogram the venous plasma levels of bupivacaine were measured up to 60 min after blockade. The results showed no changed in cardiac output. Except for one case with bradycardia--which could be treated with atropine--no changes in heart frequency occurred. Tachy- or bradycardia was not seen at all. Besides rare respiratory sinus arrhythmia no arrhythmia could be detected. The venous plasma levels of bupivacaine increased after 30 min up to 0.81 microgram/ml. The highest concentration measured was 1.45 microgram/ml 10 min after injection of bupivacaine. According to the results of the study the following statement can be given: Following bupivacaine 0.75% (2 mg/kg) given epidurally no changes in cardiac output, no changes in beat frequency, no pathological changes in cardiac rhythm and no specific cardiac toxicity related to bupivacaine 0.75% could be found in this study.

Adult↗
PubMed1986

[Effect of different injection technics on the blood level of lidocaine following intravenous regional anesthesia].

Nine volunteers received two intravenous regional anaesthetics in the right arm. The first anaesthetic consisted of an injection of 0.5% lignocaine (0.5 ml/kg body wt.), immediately followed by 0.9% NaCl (0.5 ml/kg body wt.). The second anaesthetic consisted of 0.25% lignocaine (1.0 ml/kg body wt.). Just prior to pressure release of the cuff and 30 s, 2, 5, 10, and 20 min afterward, venous blood samples were taken from the contralateral cubital vein in both groups. Lignocaine blood levels were determined by the fluorescence polarization method with the Abbott-TDx. As expected, in the first 2 min after cuff deflation, the blood levels were significantly lower in the first group. However, the peak levels did not differ significantly between groups (5-10 min). Therefore, one can expect slightly less toxicity using the combined injection technique. No significant systemic side effects of the drug were observed. On the basis of this investigation, 0.5% lignocaine (0.5 ml/kg body wt.) followed immediately by 0.9% NaCl (0.5 ml/kg body wt.) can be recommended for IV regional anaesthesia, as this seems to be less toxic than the diluted lignocaine that is usually used.

Adult↗
PubMed1985

[Addition of muscle relaxants to intravenous regional anesthesia].

Nine volunteers received two intravenous regional anaesthetics in the right arm. The first anaesthetic was performed with plain 0.25% lignocaine (dose 1 ml/kg body weight), the second with the same volume of lignocaine, with the addition of 0.5 mg pancuronium-Bromide. Latency for onset of the following was measured in both groups: 1. analgesia, 2. cold sensation, 3. warm sensation, 4. touch, 5. motor blockade. As expected, the addition of pancuronium had no influence on sensory blockade, however, motor block was significantly stronger, faster in onset, and longer in duration. Significant systemic side effects after pancuronium were not observed. No pancuronium was found in flame photometry plasma studies. On the basis of these investigations, one can recommend, for I.V.R.A., a relatively large volume of dilute local anaesthetic solution and, to achieve better muscle relaxation, the addition of 0.5 mg of pancuronium.

Adult↗
PubMed1984

[The question of equal potency of etidocaine and bupivacaine in peridural anesthesia].

A double blind clinical trial was carried out on randomised groups of 20 patients each undergoing surgery for varicose veins to compare the actions of etidocaine 1% and bupivacaine 0.5% and 0.75% with adrenaline 1:200.000. Bupivacaine 0.75% and etidocaine 1% were found to be equipotent, with a rapid onset and long duration of anaesthesia, and a comparable degree of profound motor block. The latency period of Etidocaine was markedly increased in the L V and S I segments, probably due to its high fat solubility. 0.5% bupivacaine, compared to the other preparations, showed significantly less motor block and duration of analgesia. Unlike other investigators, "spotty-analgesia" was not found in this series.

Acetanilides↗
PubMed1983

[Effect of glucose concentration on spinal anesthesia with bupivacaine 0.5%].

Until recently isobaric agents were relatively seldom employed to produce spinal anaesthesia. Experience with bupivacaine has shown in a prospective study on 60 patients, that complications, especially with high or total spinals, are uncommon with either using hyper- or isobaric agents. Also it has been shown that the height of blockade after using hyperbaric agents can only be crudely controlled by positioning of the patient. 3 ml (15 mg) of 0.5% bupivacaine produces adequate analgesia, and muscle relaxation, rapidly, in the vast majority of patients. The duration of blockade was adequate for longer surgical procedures, and was not affected by varying glucose concentrations in the solutions employed. Also there was no difference in the number of dermatomes blocked. No significant differences could be found between the solutions containing 5 or 8% glucose; however, with the 8% concentration smaller variations were found in regard to the extent of dermatomal blockade. The degree of motor block was identical in all 3 groups. The duration of motor block decreased when using higher concentrations of glucose. It is not clear whether the differing glucose concentrations have an effect on C.S.F. osmolarity, and whether this is clinically relevant. The results show that isobaric spinal anaesthesia is at least as reliable as hyperbaric spinal anaesthesia.

Anesthesia, Spinal↗
PubMed1982

[Sex difference related complication rates after spinal anaesthesia (author's transl)].

A retrospective study by questionnaire was carried out on 3056 patients (1457 female and 1599 male patients) to ascertain morbidity after spinal anaesthesia with 0,5% isobaric bupivacaine, with special regard taken to the incidence of post spinal headache. It was found that in female patients below the age of 50 the incidence of complaints was higher than in male patients, especially in the 30-50 year range. In male patients the incidence was higher in the 40-60 year group, with the highest incidence in the 50-60 year olds. The size of needle employed played a definite role. The complaints distributed according to the site of operation showed a dependence on age and size of needle. Altogether, 324 post spinal headaches were detected, 194 (13.3%) in female patients, significantly more than the 130 (8.1%) reported by male patients. In patients over 60, the incidence dropped and there was no sex difference. There was a higher incidence of headache with larger needles used for spinal anaesthesia. 84% the headaches cleared up within 2 weeks. Only in 9% did the headache persist longer than 4 weeks.

Adolescent↗
PubMed1981

[About the antimicrobial activity of substituted aromatic aldehydes (author's transl)].

The MIC-values and the antimicrobial activity in the paper disc diffusion method of 86 resp. 79 substituted aromatic aldehydes have been investigated. Antibacterial activity has been tested against Staphylococcus aureus, Pseudomonas aeruginosa, Proteus vulgaris and Klebsiella pneumoniae, the antifungal activity against Trichophyton mentagrophytes, Aspergillus niger and Candida albicans. 13 classes of substituents have been investigated. The most active compounds are substituted with nitro-, hydroxy- and halogen groups.

Aldehydes↗