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Biomedical subjects

J Jage

Publications and source records attributed to J Jage.

At least 37 records · Page 2Linked to original sources
PubMed1996

Cocaine or phenylephrine/lignocaine for nasal fibreoptic intubation?

In order to assess if a mixture of phenylephrine/lignocaine is as effective as cocaine for local analgesia and vasoconstriction during nasal fibreoptic intubation, 99 patients receiving topical nasal analgesia either with cocaine 10% or a mixture of phenylephrine 1% and lignocaine 4% were studied in a randomized double-blind investigation. After topical analgesia a flexible fibreoptic endoscope was advanced through a nostril. Larynx, glottis and trachea were endoscopically sprayed with lignocaine. Following induction of anaesthesia a nasotracheal tube was inserted fibreoptically. Pain intensity and amount of epistaxis during endoscopy were assessed. Blood pressure, heart rate and ECG-ST segment were determined before and after topical nasal analgesia, after induction of anaesthesia and after nasotracheal intubation. There were no significant differences in pain intensity of epistaxis between groups during endoscopy, nor significant alterations in haemodynamic parameters or ST-segment. It is concluded that the mixture of phenylephrine and lignocaine is a useful alternative to cocaine for local analgesia and vasoconstriction during nasal fibreoptic intubation.

Administration, Intranasal↗
PubMed1995

Development of a HPLC-system for quantitative measurement of lidocaine and bupivacaine in patients plasma during postoperative epidural pain therapy.

A HPLC method was developed for the simultaneous quantitative analysis of lidocaine and bupivacaine in plasma, with bupivacaine serving as the internal standard for the assessment of lidocaine and vice versa. The samples are prepared by diethyl ether-extraction of the alkalified plasma and re-extraction using diluted sulphuric acid. This allows the elimination of interfering medication and plasma proteins. The prepared samples are chromatographed with a Merck LiChroCART Superspher 60 RP-select B cartridge column, the local anesthetics are detected using UV-photometry and the concentration is calculated by comparing the peak areas of the analyzed substance and the internal standard. Using a sample volume of 1 ml plasma, concentrations of approximately 2.5 micrograms/ml and 1 microgram/ml can be analyzed with a 95%-confidence interval of 2.5% or 5%, respectively. At higher or lower concentrations, accurate results can be obtained using smaller or larger plasma samples. The evolved analytical method allows the rapid and simple determination of lidocaine and bupivacaine plasma levels at a wide range of concentrations. It is suitable for research purposes as well as for routine analyses.

Analgesia, Epidural↗
PubMed1994

Pharmacology and toxicology of chronically infused epidural clonidine.HCl in dogs.

To evaluate the physiological effects and toxicity of epidural clonidine.HCl, male Beagle dogs were prepared with chronic lumbar epidural catheters and administered constant infusions of either saline (N = 10), or 80 micrograms/hr (N = 6), 200 micrograms/hr (N = 6), or 320 micrograms/hr (N = 12) clonidine.HCl at a rate of 4 ml/24 hr for 28 days. Saline infusion had no effect upon any behavioral measure. Epidural clonidine produced a dose-dependent increase in thermal skin-twitch response latency (antinociception), lowering of respiration rate, heart rate, and blood pressure, and increased sedation. The effects were maximum from approximately Day 1 to Day 3 when, with the exception of respiration which remained depressed, a progressive adaptation was observed over the course of the study. There were no negative effects on body weight, body temperature, motor function, bowel or bladder function, or clinical pathology values. After 28 days of continuous infusion, the dogs were deeply anesthetized and terminated. Cisternal cerebrospinal fluid taken at termination displayed no clinically significant differences in protein or glucose concentration. All groups, including control, had dogs which had a chronic inflammatory response in the epidural space, as represented by fibrosis, foreign body giant cells, and lymphocytes, but no spinal cord pathology. Both the steady-state plasma and CSF concentrations of clonidine were proportional to the dose; the ratio of CSF to plasma concentration was approximately 0.5. The failure to see any change in CSF composition, significant spinal cord pathology, or signs of tissue or organ toxicity emphasizes the safety of epidurally administered clonidine at infusion rates up to 320 micrograms/hr and at infusate concentrations up to 2 mg/ml.

Analgesia↗
PubMed1993

Circulatory effects of vasoconstrictors combined with local anesthetics.

Vasoconstrictors are clinically used as adjuvants to local anesthetics to improve anesthetic action and to minimize local bleeding. Accidental intravascular injection or rapid systemic absorption of vasoconstrictors can induce a number of potentially life-threatening circulatory risks, which are described in this paper.

Anesthesia, Dental↗
PubMed1990

[Axillary blockade of the brachial plexus using 60 ml prilocaine 0.5% vs. 40 ml prilocaine 1%. A clinical study of 144 patients carried out by the determination of the prilocaine concentration in the central venous blood and by the measurement of the subfascial pressure in the plexus following the injection].

We estimated in this study the efficacy of axillary plexus blockade with 60 ml prilocaine 0.5% (300 mg). Following electrostimulation of the median, radial or ulnar nerve (depending on the area of the hand to be operated on), we injected prilocaine in two groups of patients (large volume group, 60 ml prilocaine 0.5% in 20 s; n = 114 patients; normal volume group, 40 ml prilocaine 1% in 20 s; n = 30 patients). Anesthesia of the median and ulnar nerves was virtually complete in all patients, but anesthesia of the radial and musculocutaneous nerves was complete in only 67% (radial) and 75% (musculocutaneous) in the group with normal injection volume. The injection of a larger volume but a lower concentration of prilocaine (300 mg) achieved better anesthesia of the radial (81%) and musculocutaneous (92%) nerves by 30-60 min after the injection. This difference was significant (p less than 0.05). The measurement of higher subfascial pressure in the axillary plexus following the larger volume of 60 ml than after 40 ml could explain the improved efficacy in overcoming anatomical hindrances in the plexus space. Estimation of the prilocaine concentration in the central venous blood 120 min after injection did not reveal different plasma concentrations in the two groups. The plasma concentrations were far below toxic levels. Only the time of plasma peak was earlier in the group with the larger volume, which was attributed to the larger area of diffusion of the vascular system in the plexus space.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Methadone--pharmacokinetics and pharmacodynamics of an opiate].

Methadone is described in this review as a potent analgesic agent; in Germany it is seldom administered as a therapeutic agent. It has the following pharmacokinetic properties: high lipophilicity, large volume of distribution (initial and steady state), low clearance (hepatic capacity limited) with a long terminal elimination time, high bioavailability following oral administration, and a tendency to accumulate in the blood and tissues. The review also considers pharmacodynamic aspects of methadone, which in Germany is available only in the levo-rotatory form; all the effects are conditioned by this l-enantiomer. In other countries methadone is successfully used over the following range of indications: intra- and postoperative pain (intravenous and epidural administration), cancer pain, and non-malignant painful conditions. The concepts of minimal effective analgesic concentration in the blood plasma (MEAC) and concentration required for 50% relief on pain are discussed. The MEAC is lower for the l-isomer than for the racemate. Methadone alone is a good analgesic agent that has slight effects in the form of respiratory depression, to which partial tolerance builds up in the course of long-term use of the drug. The interaction between methadone with alcohol, benzodiazepines, and barbiturates can be dangerous.

Analgesics, Opioid↗
PubMed1988

[Anesthesia and analgesia in opiate dependence].

This review is devoted to problems that can arise in analgesia and anesthesia in opiate addicts. The following factors are especially important: psychic disorders, heart, lung, liver and kidney disease, AIDS, and tolerance to opiates. Withdrawal of opiates during the perioperative period has a detrimental effect, and the addicted patient should therefore receive generous premedication. Practical experience in the United States of America has shown that the prophylactic administration of methadone is beneficial and prevents withdrawal symptoms. General anesthesia and regional anesthesia are both possible. It is possible to give opiates during general anesthesia achieved with preparations given by inhalation (isoflurane), but it must be borne in mind that high doses are necessary because of these patients' tolerance levels. When regional anesthesia is used for surgery or for postoperative anesthesia, it is important to observe the neurological contraindications. High doses of opiates can be administered (s.c., i.m., p.o., continuous infusion) for postoperative analgesia in opiate addicts with no fear of respiratory depression, with further analgesic treatment as and when necessary (antidepressants, anti-inflammatory agents, neuroleptics, electroacupuncture). Attention is drawn to clonidine as a particularly good drug for the treatment of opiate withdrawal. Problems encountered with abstinent drug addicts are discussed.

Analgesia↗
PubMed1976

[Determination of lipids in serum and erythrocytes during surgery with extracorporeal circulation].

The changes of the lipids in serum and erythrocytes inclusively the fatty acid pattern of the phosphatids were registered at 16 patients of whose congenital heart defects were corrected with extracorporeal circulation. The differently evident changes of the lipid fractions are to relate to heparinization, hemodilution and injury of erythrocytes which is increasing in the duration of perfusion. They are discussed in their importance for clinical essential phenomenous as disturbances of the coagulation or hemolysis. From these preliminary studies is to conclude that the substitution of phosphatids is necessary at the end of or after the extracorporeal circulation.

Adolescent↗