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Biomedical subjects

J Chrubasik

Publications and source records attributed to J Chrubasik.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Morphine metabolism in critical patients with need-directed peridural morphine infusion for the management of postoperative pain].

For constant analgesia after abdominal surgery, 34 patients (Group I) and 14 patients under intensive care (Group II) received epidural morphine infusions at mean hourly rates of 0.23 +/- 0.04 mg morphine in the first hour to 0.01 +/- 0.0 mg in the 50th hour, and 1.55 +/- 0.26 mg in the first hour to 0.20 +/- 0.08 mg in the 50th hour, respectively, after an initial bolus injection of 2 mg morphine. Whereas in Group I metabolized morphine immunoreactivity reached a plateau within 20 minutes which lasted until 8 p.m. on the operation day, in Group II a far higher plateau (p less than 0.001) was attained,--but only after some hours--which lasted until 8 p.m. on the first postoperative day. In the course of the treatment, concentrations of metabolized morphine immunoreactivity in serum and in urine decreased in both groups.

Antibodies↗
PubMed1985

Intrathecal somatostatin in terminally ill patients. A report of two cases.

Intrathecal morphine has been shown to be reliable in producing analgesia in patients with intractable cancer pain. Recently, we have demonstrated that intrathecal somatostatin is as effective in the treatment of cancer pain as intrathecal morphine. This report presents 2 cases in whom analgesia could be maintained for 60 and 25 days, respectively, under continuous intrathecal infusion of somatostatin by means of infusion devices.

Aged↗
PubMed1985

Continuous-plus-on-demand epidural infusion of morphine for postoperative pain relief by means of a small, externally worn infusion device.

In this study, 50 patients received an initial bolus epidural injection of 2 mg morphine-hydrochloride followed by a continuous-plus-on-demand epidural infusion of a 0.25% morphine-hydrochloride solution by means of a small, externally worn infusion device, for constant pain relief after abdominal operations. Mean morphine consumption on the operation day (until 8:00 AM on the first postoperative day) was 4.8 +/- 0.2 mg, on the first postoperative day (until 8:00 AM on the second postoperative day) 1.9 +/- 0.2 mg, and on a second postoperative day until 8:00 PM, 0.6 +/- 0.1 mg. The mean morphine consumption over 50 h was 7.1 +/- 0.3 mg; in the first 25 h and in the following 25 h after the operation, 5.44 +/- 0.3 mg and the significantly lower amount of 1.64 +/- 0.2 mg morphine, respectively, were consumed (P less than 0.001). There were no serious side effects. Serum levels of free, unmetabolized morphine immunoreactivity decreased during the treatment. The described method is recommended for treating postoperative pain, as it offers constant analgesia and the possibility of individualized treatment.

Abdomen↗
PubMed1985

[Initial studies on the intraoperative use of spinally administered somatostatin].

7 cases are reported demonstrating that intrathecal or epidural administration of somatostatin intraoperatively reduced the requirement for other anaesthetics. Somatostatin acts as a potent analgesic, which does not impair circulatory parameters and which possesses no centrally depressing effect. Spinal administration of somatostatin could therefore gain importance in high-risk category patients with normal metabolism.

Adult↗
PubMed1985

The effect of epidural somatostatin on postoperative pain.

The epidural injection of a bolus of 250 micrograms somatostatin followed by continuous epidural infusion provided complete postoperative relief of pain in eight patients who had undergone abdominal surgery; no other analgesics were required. In two patients, intravenous and intramuscular naloxone had no effect on the analgesia provided by epidural somatostatin. In two patients, epidural somatostatin also produced adequate intraoperative analgesia. Epidural somatostatin was associated with no side effects.

Aged↗
PubMed1985

[Somatostatin. A review].

This review is a presentation of the various effects of somatostatin within the central nervous system and the gastrointestinal tract. Attention is focused on the analgesic effect of somatostatin, which can be induced by intrathecal or intraventricular, or by epidural administration. Chronic, morphine-responsive pain in terminal cancer patients or acute postoperative pain can be effectively treated by spinal administration of somatostatin. Intraoperative application of somatostatin saves on using anesthetics. However, further investigations are necessary to determine the limitations of spinal administration of somatostatin.

Adult↗
PubMed1985

[No loss of analgesic effect by peridural low volume morphine administration].

The risk of respiratory depression after epidural bolus injections of morphine can be reduced by lowering the injection volume of bolus epidural injections. The aim of the investigation was to evaluate the analgesic effectiveness of low-volume epidural injections of morphine and to determine the relationship between morphine consumption and the time of commencement of treatment by epidural, on-demand, low-dose infusion of morphine for constant pain relief after abdominal operations. Two mg morphine were administered immediately prior to the epidural infusion at the initial basal rate of 0.16 mg/0.06 ml per hour. The sixteen patients of Group I received an initial morphine bolus injection in a 10 ml volume of saline after complaining of worst post-surgical pain. The 34 patients that comprised Groups II and III in a randomised investigation received the initial 2 mg morphine in 1 ml saline. The treatment of Group II (n = 14) commenced when the patients complained of worst pain, in Group III (n = 20) after the patients had been extubated and were awake but before they complained of pain. Mean morphine consumption of the three groups until 8 a.m. on the first postoperative day did not differ significantly. We may, therefore, conclude that reduction of the injection volume does not result in loss of analgesic effectiveness, and that the treatment should commence as early as possible so as to spare the patient's pain. If the epidural catheter's tip is placed in the spinal area of the maximum nociceptive input, low-volume administration of morphine should be definitely employed.

Abdomen↗
PubMed1985

[Influence of the volume of peridural morphine bolus injections on morphine concentration in the cisterna magna of the dog].

14 dogs received randomly a bolus injection of either 2 mg morphine in 10 ml isotonic saline solution or 2 mg morphine in 1 ml isotonic saline solution epidurally at T6. An epidural infusion of 0.16 mg morphine/0.06 ml/h was applied immediately following the 1 ml bolus injection of morphine. Cisternal cerebellomedullary CSF samples were taken at varying intervals to determine free morphine immunoreactivity by radioimmunoassay. Within 20 min after the 10 ml bolus injection the peak CSF morphine concentration of 3594 +/- 910 ng/ml was reached. Following this, CSF morphine levels decreased exponentially and after 48 h 8 +/- 3 ng/ml were measured. The peak CSF morphine concentration of 139 +/- 51 ng/ml was, however, reached only after 2 h following the 1 ml bolus injection plus the infusion treatment. Despite the additional infused amount of 7.68 mg over 48 h the CSF morphine concentrations decreased also exponentially and after 48 h 16 +/- 4 ng/ml were measured. One may conclude, therefore, that the risk of respiratory depression is negligible under epidural infusion treatment following an initial "Low-Volume"-bolus injection of 2 mg morphine, a recommendable method for treating post-operative pain. High-volume bolus injections of morphine should generally be abandoned in epidural treatment of pain.

Animals↗
PubMed1984

[Morphine concentrations in serum in need-controlled peridural morphine infusion].

After abdominal or thoracoabdominal operations, an epidural, on-demand morphine infusion following an initial bolus injection of 2 mg morphine was administered to 48 patients for postoperative pain relief. 34 non-intubated patients (Group I) and 14 artificially ventilated patients under intensive care conditions (Group II) received morphine solutions of 0.25% (maximum flow rate 0.31 ml/h) and 0.4% (maximum flow rate 0.5 ml/h), respectively. Total morphine consumption of the intensive care patients (Group II) until 8 p.m. on the 2nd postoperative day was 34.0 +/- 2.9 mg and was significantly higher than in non-intubated patients (Group I), with 6.4 +/- 0.4 mg (p less than 0.001). Although serum concentrations of free and metabolized morphine immunoreactivity declined in both groups in the course of treatment in accordance with the decreasing morphine demand, pharmacokinetics varied between the two groups. Whereas serum concentrations of free morphine immunoreactivity in group I, which decreased multiexponentially following the 2 mg. bolus injection, were not influenced by morphine infusion rates, serum morphine immunoreactivity in group II showed an increase until 8 p.m. on the operation day (p less than 0.005). Metabolized morphine reached plateau concentrations in both groups because of its relatively long half-life: the plateau in group II patients was significantly higher, was reached later and lasted longer than that of group I (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗