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Biomedical subjects

I Acalovschi

Publications and source records attributed to I Acalovschi.

At least 19 recordsLinked to original sources
PubMed2001

Tramadol added to lidocaine for intravenous regional anesthesia.

UNLABELLED: Sixty volunteers, divided into four groups of 15 each, received IV regional anesthesia of the upper limb with 40 mL tramadol 0.25%, sodium chloride 0.9%, lidocaine 0.5%, or 100 mg tramadol-containing lidocaine 0.5%. By using a double-blinded method, we tested the onset and recovery of sensory block at six sites of the forearm and hand as well as onset of complete motor block. The symptoms after deflation of the tourniquet were recorded. The onset and recovery of sensory block and the onset of motor block were similar in the tramadol and saline groups. However, in the Tramadol-Lidocaine Group, the speed of onset of sensory block was faster than in the Lidocaine Group. In the Tramadol and the Tramadol-Lidocaine Groups, the incidence of skin rash and painful or burning sensation at the injection site was increased. We conclude that tramadol 0.25% does not have a local anesthetic effect when used as a sole drug for IV regional anesthesia, but might modify the action of local anesthetic, providing a shorter onset time of sensory block. IMPLICATIONS: Tramadol, a centrally acting analgesic, might have local anesthetic properties, as do some opioid drugs. We demonstrated that 0.25% tramadol solution containing 100 mg tramadol is not effective as a sole drug, but may improve the action of 0.5% lidocaine for intravenous regional anesthesia. The increased incidence of side effects may limit the clinical use of tramadol.

Adult↗
PubMed1997

Spinal anesthesia with meperidine. Effects of added alpha-adrenergic agonists: epinephrine versus clonidine.

We determined the effects of intrathecally administered epinephrine and clonidine on the duration and quality of a meperidine spinal block. Forty-five patients scheduled for orthopedic surgery, divided into three groups, received spinal anesthesia with 1 mg/kg 5% meperidine, alone or with 200 microg epinephrine or 2 microg/kg clonidine. Using a double-blind method, the onset, extension, and duration of sensory block (to pinprick) and the duration and degree of motor block (Bromage scale) were assessed. Hemodynamic responses, duration of postoperative analgesia, degree of sedation, and occurrence of side effects were also recorded. The addition of epinephrine to the meperidine solution prolonged the sensory block (P<0.01) but did not affect its onset or extent. A similar potentiating effect was demonstrated for clonidine (P<0.001). The duration and degree of motor block were increased by addition of both epinephrine and clonidine. A tendency toward bradycardia and a decrease of mean arterial pressure was potentiated by clonidine but not by the epinephrine. Only the addition of clonidine prolonged the postoperative analgesia (P<0.001), but was associated with an increased sedation score. The incidence of other side effects did not differ between the groups. We conclude that coadministration of epinephrine or clonidine with meperidine enhances the duration and degree of spinal anesthesia and that adding clonidine prolongs the duration of postoperative analgesia.

Adjuvants, Anesthesia↗
PubMed1995

Intravenous regional anesthesia with meperidine.

Forty-five ASA physical status I volunteers, divided in three groups of 15 each, received intravenous regional anesthesia (IVRA) of the upper limb with 40 mL meperidine 0.25%, lidocaine 0.5%, or 0.9% sodium chloride (isolated ischemia) by random allocation. Using a double-blind method, the onset and recovery of sensory block was tested at six sites of the forearm and hand. The onset of complete motor block was also assessed. The symptoms after deflation of the tourniquet were recorded. The onset of block, as determined by pin-prick touch, and cold was significantly faster in the meperidine group (P < 0.001) than in the saline group, but also slower (P < 0.001) than in the lidocaine group. After the tourniquet was deflated, recovery occurred in reverse order. A complete motor block was noted in all volunteers from the meperidine and lidocaine groups, but in only 11 cases from the 0.9% sodium chloride group (P < 0.01). In the meperidine group, motor block developed concomitantly or prior to sensory block. There was a significant increase in the incidence of dizziness, nausea, and pain at the injection site in the meperidine group in comparison with the lidocaine group. We conclude that meperidine has local anesthetic action on the peripheral nerve in vivo, but that its single use for IVRA should be a second choice for patients allergic to local anesthetics.

Adolescent↗
PubMed1995

The effects of propofol on laryngeal reactivity and the haemodynamic response to laryngeal mask insertion.

The ease of the insertion of laryngeal mask and the haemodynamic response were assessed 2 min after induction of anaesthesia with either propofol 2.5 mg kg-1 or thiopentone 4.0 mg kg-1 in 38 ASA I premedicated patients. The inserting conditions scored as excellent, good, poor and unable to insert were significantly better with propofol than with thiopentone (P < 0.001). Insertion of the laryngeal mask was followed by a transient but significant increase in both systolic (P < 0.05) and diastolic (P < 0.01) arterial pressure in the thiopentone group; there was no comparable response in the propofol group. The heart rate varied little from baseline in both groups.

Adjuvants, Anesthesia↗
PubMed1992

[Late reinterventions after the surgical treatment of gastric and duodenal ulcer].

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.

Adult↗
PubMed1990

Nonsurgical control of upper gastrointestinal hemorrhage in old age patients: intragastric norepinephrine and endoscopic alcoholization of lesions.

Of 28 consecutive patients over 64 years old, in whom endoscopy revealed gastro-duodenal ulcers with signs of recent hemorrhage (active bleeding, non-bleeding vessel or adherent clot), 14 were randomly assigned to receive endoscopic alcoholization of the lesions preceded by intragastric instillation of norepinephrine, while as controls 14 received antacids. After the applied treatment the bleeding stopped in all cases (100%) in the study group and one patient died (7.1%) after hemostasis was achieved. In the control group bleeding stopped in 12 patients (85.7%). Two patients continued to bleed and needed emergency surgery. Another patient had a major rebleed successfully treated by alcoholization. There were 4 deaths (28%): 2 patients died postoperatively and the other 2 from acute porphyria and bronchopneumonia respectively. The transfusion requirements after the entry into trial were significantly lower in the study group compared to controls (mean no. of blood units 0.79 vs. 1.71). No complications were seen with the treatment applied. These results suggest that endoscopic alcoholization of the lesions preceded by intragastric instillation of norepinephrine is an effective and safe emergency therapy for bleeding from peptic ulcers in old age patients.

Aged↗
PubMed1988

Reduction of surgery and mortality rate of bleeding peptic ulcer by endoscopic haemostasis with alcohol.

Eighty patients with peptic ulcers (45 duodenal ulcers, 30 gastric ulcers, and 5 stomal ulcers) presented at our emergency endoscopy unit with acute upper gastrointestinal haemorrhage (Forrest Ia, spurting bleeding; Forrest Ib, oozing bleeding) or stigmata of recent bleeding (Forrest II). They were divided into two groups, A and B, according to the day of the week on which emergency endoscopy was performed. Group A, consisting of 39 patients (24 duodenal ulcers, 13 gastric ulcers, and 2 stomal ulcers) was submitted to conventional treatment (blood transfusions, antacids, cimetidine, pirenzepine). Group B consisted of 41 patients (21 duodenal ulcers, 17 gastric ulcers and 3 stomal ulcers) on whom endoscopic haemostatic injection with absolute alcohol (Asaki's method) was performed. Patients of both groups underwent emergency surgery if the haemorrhage did not stop or if it recurred. In 10 cases (4 in group A and 6 in group B), elective surgery was performed, i.e. several days after the bleeding episode under conditions of haemodynamic safety. Endoscopic injection of absolute alcohol succeeded in arresting the haemorrhage in 17 of the 18 Forrest Ia and Ib cases and prevented recurrence in all Forrest II cases. Significant differences were recorded between the two groups as regards the number of patients undergoing surgery (18 to 7), emergency surgery (14 to 1) and the mortality (15% compared to 2.4%). The greatest difference was recorded between the postoperative mortality (27% in group A and 0% in group B).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Saddle block with pethidine for perineal operations.

Saddle blockade with pethidine hydrochloride was performed in 111 patients undergoing short surgical operations on the perineum. A dose of 5% pethidine 0.5 mg kg-1 was injected to the subarachnoid space at L4-5 or L5-S1 with the patient in the sitting position. Sensory blockade was achieved in 5.28 +/- 1.43 min. This extended to the sacrococcygeal area, perineum, buttocks and posterior surface of thighs, and was followed 1-2 min later by motor blockade. During the operation the patients were stable haemodynamically and no respiratory depression was recorded. Sensory blockade lasted for 141 +/- 26.06 min and was followed by postoperative analgesia, the mean duration of which was 301 +/- 98.38 min. Postoperative neurological complications were recorded in three patients (2.7%): headache alone in one, headache associated with backache in one, and leg weakness, backache, nuchal rigidity and photophobia in another. Seven patients (6.3%) complained of itching, five patients (4.5%) of nausea and vomiting and two (1.8%) developed urinary retention.

Adult↗
PubMed1976

Factors influencing the establishment of the normal values of the respiratory activities of human liver mitochondria.

Some factors that influence the values of respiratory activities of liver mitochondria isolated from surgical biopsy specimens have been studied. By sedimentating of mitochondria at a lower centrifugal force (5,500 g) than usually used for rat liver mitochondria, and washing the mitochondrial pellet twice, the contamination with lysosomes and microsomes was lowered. At 37 degrees C, and in the presence of hexokinase and glucose, the oxygen uptake was greater than at 25 degrees C and in their absence. The respiratory control was good and the respiratory activities were rather stable during the first 3-4 h after isolation. The respiratory activities of mitochondria isolated from patients with duodenal or gastric ulcers, biliary diseases, and subjects with no digestive diseases (all having normal liver) were compared. Differences in oxygen uptake and acceptor control index values with some substrates were noted. The conditions for selection of controls in studies on subcellular fractions of human liver include: absence of any hepatic antecedents; no clinical evidence of liver involvement; no abnormality in routine liver function tests; a histologic aspect free of pathological conditions, and a normal aspect of the tissue during the homogenization and the fractionation procedure (absence of steatosis or fibrosis). These data provide a basis for the standardization of methods in establishing the reference values of mitochondrial activities for the modifications in a variety of diseases.

Acid Phosphatase↗