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Biomedical subjects

J Biscoping

Publications and source records attributed to J Biscoping.

71 records · Page 4Linked to original sources
PubMed1985

[Hygienic relations and stability of drugs in peridural long-term infusion with implanted or external pumps].

Implantable devices (implanted pump/implanted catheter and port) are recommended for continuous epidural application of opiates or local anaesthetics in order to reduce hygienic problems during long term epidural medication. No signs of contamination could be found during bacteriologic culture of residual volumes of 30 patients treated with epidural drug delivery systems and of samples collected during an in vitro investigation (incubation of filled external pump systems at body temperature/storage of syringes with a premixed solution of opiate and local anaesthetic for repeated epidural bolus application). As demonstrated in a case report prophylactic antibiotic coverage prior to implantation may be necessary in patients with a preexisting susceptibility to infection. The concentrations of morphine (radioimmuno-assay) and of bupivacaine (gas-solid chromatography) within the reservoir were stable during clinical therapy as well as during the in vitro experiments.

Abscess↗
PubMed1985

[Acid-base findings in the cerebrospinal fluid of premedicated patients].

Analysis of acid-base-metabolism in cerebrospinal fluid is not easy, because pO2, pCO2 and pH change already within a short time after sampling. Acid-base-values in CSF have been measured in 50 healthy patients within 20 seconds after withdrawal. Our results (pH 7.298 +/- 0.007; pCO2 46.94 +/- 4.84 mmHg; HCO3 22.78 +/- 2.15 mVal/l; BE-2.4 +/- 2.39 mVal/l; pO2 50.27 +/- 14.06 mmHg) demonstrate, that CSF is more acidic than often claimed. This is important, whenever possible precipitations by intrathecal injection of local anaesthetics are discussed.

Acid-Base Equilibrium↗
PubMed1985

[Plasma levels of bupivacaine following inadvertent intravascular injection via a peridural catheter].

We report on a 57 year old woman, who suffered from an inadvertent intravascular injection of bupivacaine via a perforating epidural catheter. At the end of the epidural injection she showed symptoms of toxicity caused by the local anaesthetic. Venous blood dripping out of the epidural catheter and central venous blood were sampled simultaneously and analysis of plasma levels of bupivacaine were performed.

Anesthesia, Epidural↗
PubMed1985

[Catheter brachial plexus anesthesia for intra- and postoperative pain control. Plasma concentrations and analgesia interval in the use of bupivacaine].

In 15 orthopedic patients, undergoing plastic surgery of the upper extremity (elbow, forearm, hand) we studied plasma levels and pain free intervals, when performing catheter axillary plexus block with 0.5% and 0.25% bupivacaine as postoperative analgetic agent respectively. 30 minutes after injection of 40 ml of 0.5% bupivacaine maximum plasma levels were reached (means = 1.46 micrograms/ml), followed by a constant but slow decrease to 1 microgram/ml approximately after 2 h. 11.5 h (mean) after brachial plexus block there was a need for reinjection of local anesthetic solution for postoperative pain control. The pain free interval after 30 ml of 0.25% bupivacaine lasted 10.5 hours on the average. The 'top-up-dose' of 75 mg approximately equal to 30 ml of 0.25% bupicavaine caused only a small rise in plasma levels up to 0.6 micrograms/ml. Catheter brachial plexus block with bupivacaine is an appropriate procedure for both intra- and postoperative pain relief, especially in re-implantation surgery of the upper limb.

Adult↗
PubMed1985

[Comparative studies on dose adjustment of intraoperative lidocaine therapy in heart failure patients].

From 10 patients with myocardial insufficiency arterial blood samples were taken, in order to study lidocaine plasma concentrations following reduced iv. bolus administration (0.5 mg/kg body weight) and subsequent infusion (2 mg/min). Drug concentrations were monitored by means of gas chromatography. The results obtained from the reduced loading dose of lidocaine were nearly identical to those from patients without myocardial insufficiency and an iv. bolus injection of 1 mg lidocaine/kg body weight. The reduced hepatic metabolism of lidocaine caused by manifest myocardial insufficiency requires a significantly reduced loading dose not exceeding the therapeutic range, even in intraoperative short-term use.

Anesthesia, General↗
PubMed1984

[Plasma level of lidocaine following intraoperative bolus injection and infusion in heart failure].

In two groups of ten patients each (group I: myocardial insufficiency, group II: no myocardial insufficiency) during anaesthesia arterial plasma levels of lidocaine were studied, following iv bolus administration (1 mg./kg. bw) and subsequent lidocaine infusion (2 mg./min.) for 15 minutes. With this dosage, recommended for antiarrhythmic therapy, plasma levels exceeded the therapeutic range in group I and in some patients reached almost toxic levels (10 micrograms./ml.). In group II lidocaine plasma levels were within the therapeutic range (1,5-4 micrograms./ml.). In patients with myocardial insufficiency and/or reduced hepatic metabolism antiarrhythmic therapy with lidocaine has to be performed with significantly reduced dosages; drug monitoring is recommended.

Arrhythmias, Cardiac↗
PubMed1984

[Plasma levels following lumbar epidural anesthesia with 0.75% bupivacaine].

In ten patients undergoing total hip replacement, plasma levels of bupivacaine were studied, following lumbar epidural administration, with special reference to the early phase. In contrast to previous studies concerning the 0.5% solution, we found an early rise between 3 and 5 min, which was nearly identical with the peak level. The maximum concentration was 2.76 micrograms/ml and within the estimated safety margin. The necessity of preventing acidosis and hypoxia is pointed out when using bupivacaine 0.75%.

Acidosis, Respiratory↗
PubMed1983

[pH and buffer capacity of cerebrospinal fluid after spinal anesthesia].

In 20 patients, undergoing total hip or knee replacement, we studied pH and metabolic changes in the C.S.F. following spinal anaesthesia with two different mixtures of bupivacaine 0.5% and mepivacaine 4% hyperbaric. Our study was made with special regard to the early changes; therefore C.S.F. specimens were obtained at 1, 3, 5, 10, 20, 30, 60 and 90 min intervals and analyses of pH, pCO2, HCO3 and BE estimations were carried out immediately after each obtained sample. Our results showed a marked tendency towards acidosis and therefore do not comply with previous studies. The advantage of this fact is an improved stability of bupivacaine in C.S.F.

Aged↗
PubMed1983

[Changes in plasma amino acids during and following isolated liver perfusion in the human. Brief clinical report].

Plasma amino acids have been analysed during isolated perfusion of the liver in dogs. Aromatic amino acids increased, also the branched chain amino acids showed a small rise. Thus no signs of hepatic failure could be detected. To evaluate early signs of hepatic failure in 2 patients scheduled for isolated liver perfusion, the plasma amino acids where analysed. Corresponding to the results obtained in animals, aromatic acids increased, whereas branched chain amino acids remained constant or rose. Even in the postoperative course no signs of deterioration of plasma amino acids could be detected.

Amino Acids↗
PubMedDate not supplied

[Catheterized peridural anesthesia as a procedure for intra- and postoperative pain therapy in chemonucleolysis].

In 13 patients scheduled for intradiscal therapy with chymopapain we performed continuous lumbar epidural anaesthesia as a method of intra- and postoperative pain relief. In all patients epidural anaesthesia provided a sufficient analgesia by the use of bupivacaine 0.75% intraoperatively. In contrast to chemonucleolysis under general anaesthesia only half of the patients needed postoperative pain therapy, which was achieved by the epidural injection of bupivacaine 0.25%.

Adult↗
PubMedDate not supplied

[Metabolic changes caused by an extremities tourniquet and its modification by anesthesia procedures].

In 3 groups of 15 patients, respectively, we studied metabolic changes following tourniquet-release after operations of lower extremity. The influence of different anesthetic methods was evaluated by blood-gas-analyses up to 30 minutes after blood-circulation of the lower limb had been reinstalled. Our results demonstrate, that the patients under regional anesthesia with spontaneous respiration (group 1) could preserve their metabolic equilibrium with minor changes within the physiologic range. The intubated patients with controlled respiration (group 2) revealed a marked metabolic acidosis after tourniquet-release with insufficient respiratory compensation. Initial values were not reached within 30 minutes. The patients of group 3 (controlled respiration with a 25% increase of the normal minute volume for a period of 5 minutes after release of the tourniquet) had a less severe acidosis than those of group 2. The beneficial influence of spontaneous respiration in compensating metabolic acidosis--even in aged patients--following an ischemic tourniquet has been demonstrated by this investigation. Short-term hyperventilation seems to be the therapeutic tool in patients with controlled respiration to compensate for metabolic acidosis up to a certain extent.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Incidence of air embolism in implantation of hip prostheses].

The prosthetic supply of the hip-joint may be accompanied by the problem of venous air embolism. By including 53 orthopaedic patients having undergone total hip replacement, the influence of bone-cement as well as of the different anaesthetic techniques on the frequency of embolic phenomenons was investigated. Embolism was determined as an abrupt decrease (greater than 5 mmHg) in the end-tidal pCO2. Venous embolism often occurred with cemented endoprostheses in contrast to non-cement implantations. Patients with general anaesthesia presented more often with venous air embolism than patients with epidural anaesthesia. This might be explained by an expanding effect of nitrous oxide on air bubbles entering the vascular bed under the implantation of the shaft-prostheses. Our data stress the importance of continuous monitoring of end-tidal pCO2 for early discovery of lung embolism.

Aged↗
PubMedDate not supplied

[Pulmonary complications following Harrington's operation].

We report on a fourteen year old patient with pulmonary atelectasis following scoliosis treatment using Harrington's instrumentation. Changes in dynamic pulmonary function tests (FVK, FEV1, MF, MBC) and arterial blood gases are documented, therapy and etiology are discussed.

Adolescent↗
PubMedDate not supplied

Function of the adrenal cortex during therapy with fluconazole in intensive care patients.

An impairment of cortisol synthesis can be assumed for the new antimycotic fluconazole based on its chemical structure (triazole derivative) and mechanism of action (inhibition of ergosterol synthesis). In healthy volunteers, however, no influence on steroid hormone production could be found. The present study was undertaken to clarify whether this is also true for critically ill, long-term patients in an intensive care unit. The basal cortisol and adrenocorticotropic hormone (ACTH) levels were determined by means of radioimmunoassay in 11 patients being treated with antimycotics at fixed times. Antimycotic treatment was carried out using either fluconazole (n = 6) or a combination of amphotericin B and flucytosine (n = 5) for 14 days. Seven days after cessation of the treatment the above-mentioned hormones were again determined. Patients with the same baseline criteria who did not require antimycotic treatment (n = 8) served as controls. During the entire study period adequate cortisol synthesis was found after ACTH stimulation in all three patient groups. They all presented with relatively raised basal cortisol levels (range 16.4-31.0 micrograms dl-1) and an increase in ACTH-stimulated cortisol synthesis from 31% (group ampho B/flucytosine) to 78% (group fluconazole). The basal ACTH values were always within the normal range (9.2-16.4 pg ml-1). Neither the basal ACTH levels nor the basal cortisol levels as well as the cortisol levels determined after the ACTH test showed adrenocortical suppression in the patients of all three groups. Thus, according to the present results clinically relevant impairment of cortisol synthesis after treatment with fluconazole can be excluded.

Adrenal Cortex↗