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Biomedical subjects

J Motsch

Publications and source records attributed to J Motsch.

At least 127 records · Page 7Linked to original sources
PubMed1991

[Comparative studies of atracurium and vecuronium for medium-length surgical procedures in infants and young children].

Onset time, intubation condition and recovery time after single bolus injection of atracurium (0.3 mg/kg in body weight less than 10 kg (Group 1), 0.5 mg/kg in body weight greater than 10 kg (Group 2] and vecuronium (0.05 mg/kg in body weight less than 10 kg (Group 3), 0.1 mg/kg in body weight greater than 10 kg (Group 4] were studied in 40 infants and children anaesthetised with halothane. At the end of the onset time (time from the end of the bolus injection of the muscle relaxant until the maximal twitch depression of the m. adductor pollicis) the intubation conditions were judged as good or very good in both groups. The onset time after bolus injection of atracurium (92.5 +/- 31.9 sec in Group 1, 117.0 +/- 25.2 sec in Group 2) was slightly shorter than after vecuronium (135.7 +/- 64.1 sec in Group 3, 123.3 +/- 26.8 sec in Group 4). The duration from the time of injection to 75% recovery of T1 had been longer by using atracurium (45.2 min in Group 1 + 2) than by vecuronium (36.6 min in Group 3, 34.2 min in Group 4). In infants (Group 1 + 3) the recovery time (duration from 25% to 75% recovery of control twitch height) after relaxation with atracurium as well as vecuronium was longer than in children (Group 2 + 4). Neither cardiovascular side effects nor signs of histamine release occurred after the injection of both muscle relaxants at our dosage level. It is concluded that in infants and children atracurium is a real alternative to vecuronium for relaxation for medium long surgical procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1991

[The effect of 6% (40/0.5) hydroxyethyl starch and Ringer's lactate on blood coagulation, laboratory parameters and circulation during peridural anesthesia].

We investigated the effects of 6% hydroxyethyl starch (HES 40/0.5) and lactated Ringer solution (LRS) on blood coagulation tests and laboratory parameters during epidural anesthesia. Additionally, the efficacy of this prophylactic intravenous fluid supply in preventing sympathetic blockade induced hypotension was studied. METHODS. A single shot lumbar epidural block was given to 55 patients using 14-18 ml of bupivacaine 0.75%. The patients were randomized to receive either 1000 ml 6% HES 40/0.5 or 1000 ml LRS starting 5 min before the epidural blockade was set. The first 500 ml was infused during a 15-min period and the remaining 500 ml solution during the next 30 min. Cardiovascular parameters were recorded and blood samples were taken 30, 60, 120 and 240 min after the start of the infusion. RESULTS. No significant differences were found in the cardiovascular parameters, although in patients with a cranial spread of epidural blockade above T 10, patients who received LRS showed more episodes of severe hypotension. Serum osmolarity, potassium and sodium remained constant throughout the observation period. HES 40/0.5 caused a significantly greater hemodiluting effect than LRS, which was evident in more pronounced temporary decreases in serum protein concentration, hemoglobin concentration, hematocrit, fibrinogen and platelets. In coagulation parameters LRS caused no changes of PTT and Quick, whereas HES 40/0.5% led to a significant prolongation of PTT and a decrease in Quick. CONCLUSION. Fluid supply with either LRS or 6% HES 40/0.5 cannot prevent the epidural blockade induced hypotension entirely. In epidural anesthesia with spread of blockade above T 10, 6% HES 40/0.5 is superior to LRS in the prevention of severe hypotension. The temporary increase in plasma volume after infusion of 6% HES 40/0.5 results in a greater hemodilution with a concomitant decrease of blood viscosity and improved microcirculation flow. These might be of interest in prevention of thromboembolic complications. The specific effects of the two solutions were also determinable during epidural blockade.

Adult↗
PubMed1990

Addition of clonidine enhances postoperative analgesia from epidural morphine: a double-blind study.

This study was undertaken to evaluate the analgesic effect of the combination of epidural morphine and clonidine versus epidural morphine alone in patients with postoperative pain. A randomized double-blind design was used, and 91 patients scheduled for post-operative pain relief by epidural morphine were studied. Patients received either a continuous epidural infusion of morphine and clonidine (group 1; n = 45) or morphine alone (group 2; n = 46) over the 72 h after major abdominal surgery. In the first 24 h, the dose of morphine was 6 mg per 24 h; during the second 24 h, it was decreased to 4 mg per 24 h; and in the final 24 h, it was decreased to 2 mg per 24 h in both groups. Group 1 patients received clonidine (450 micrograms) during each 24-h period. Additional epidural bolus injections of 2 mg morphine and intravenous meperidine were given on demand. The pain score, blood pressure, heart rate, respiratory rate, and relative forced vital capacity were measured at fixed times during the first 72 h after operation. Total consumption of analgesics and side effects were recorded. Although the total consumption of analgesics was significantly higher in group 2 (P less than 0.05), pain scores were lower in group 1 than group 2 during the entire observation period (P less than 0.05). Epidural clonidine produced a significant decrease (P less than 0.05) in heart rate and blood pressure, whereas the respiratory rate was not affected. Due to the better pain relief in group 1, the forced vital capacity was increased (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Pancreatic autotransplantation in the pig: variations in epigastric arterial blood supply.

A major problem in pancreatic autotransplantation is the vascular supply of the left segment, which serves as the graft. We therefore examined the arterial blood supply of the epigastric organs in 36 German landrace pigs. In 19 pigs (anatomical variation 1) there was a pancreatic branch of the splenic artery supplying the left segment. After splenectomy the splenic artery could be used as the graft-supplying vessel. In 14 pigs (anatomical variation 2) the arterial branch for the left segment was the first branch out of the hepatic artery distal to the coeliac trunk. In these cases a splenohepatic bypass was performed to ensure delivery of the blood to the epigastric organs. Thereafter, the proximal part of the hepatic artery could be used as the vessel supplying the graft. The left segment could not be used for autotransplantation in 3 pigs (anatomical variation 3) because of the atypical vascular supply. During the 6-month observation period, no malfunction of the epigastric organs was evident.

Animals↗
PubMed1989

A model for determining the influence of hepatic uptake of nondepolarizing muscle relaxants in the pig.

Hepatic uptake and distribution of nondepolarizing muscle relaxants in pigs was investigated. A portocaval shunt preparation enabled the determination of the pharmacodynamics of nondepolarizing muscle relaxants both during temporary liver exclusion and intraportal injection in the same animal. To demonstrate the validity of the model in pigs, in a pilot study the influence of hepatic uptake on neuromuscular blockade by pancuronium (n = 3) and its congener Org 6368 (n = 3) was determined. Thereafter, the influence of hepatic uptake on neuromuscular blockade by gallamine (3.4 mg/kg, n = 5), Org 6368 (0.3 mg/kg, n = 5), and vecuronium (0.1 mg/kg, n = 4 and 0.15 mg/kg, n = 5) was studied in pigs anesthetized with pentobarbital. Each pig received one relaxant, which was injected four consecutive times under different conditions. The first injection was into the jugular vein (iv) the second into the portal vein, the third was iv while the liver was excluded for 10 min and the fourth was iv (control). After each injection the onset time, intensity, recovery rate, and total duration of neuromuscular blockade were measured. These variables were compared between the four injections for each relaxant. In the pilot study the influence of hepatic uptake on neuromuscular blockade was similar for pancuronium and Org 6368. For gallamine the onset time, intensity, recovery rate, and duration of action were similar after all four injections. For Org 6368 the variables of neuromuscular blockade were similar after iv and intraportal injection, but exclusion of the liver prolonged the neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[A computer-assisted noninvasive monitoring system with graphic display of online determination of cardiovascular parameters].

During anesthesia the cardiovascular system is usually assessed on the basis of heart rate and arterial pressure, although the most important hemodynamic measurement is that of flow. A method for the non-invasive measurement of cardiac output is based on thoracic electrical bio-impedance. The NCCOM3-R7 is a non-invasive cardiac output monitor that makes use of thoracic electrical bioimpedance, which has been shown to provide results comparable with thermodilution in various hemodynamic states both in animals and humans. A new on-line hemodynamic monitoring system has been developed using the non-invasive NCCOM3-R7 (BoMed) cardiac output monitor, a portable microcomputer (NEC Multispeed) in connection with a software package CDDP-1 (BoMed), a Dinamap automatic arterial pressure monitor (Critikon) and an additional 14" display. Every 16 heart beats the cardiac output monitor transfers 11 cardiodynamic parameters in ASCII-format to the microcomputer, where the data are stored. Using the CDDP-1 program the current cardiodynamic status of the patient is displayed numerically and graphically on the monitor screen. Mean arterial pressure is determined by Dinamap and the data must be entered manually in the menu. The program then calculates systemic vascular resistance and left ventricular work index, the CVP being set to 3 torr and PAOP to 6 torr. In the graphic display the current hemodynamic status is shown and the underlying situation is analyzed in terms of systemic vascular resistance and volume-dependent contractility. The reliability of this on-line monitoring system is demonstrated in a high-risk patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1988

[Continuous intrathecal opiate therapy with a portable drug pump in cancer pain].

Terminal cancer patients report substantial pain frequently. Pain control can be achieved in many patients with conventional methods and analgesics. However, significant numbers of patients remain in pain. For these patients, continuous intrathecal narcotics delivered by an external portable pump via a subcutaneous port, offer substantially improved pain control with minimal risk of serious systemic complications. Duration of treatment in our 40 cancer patients lasted up to 11 month. Continuous intrathecal morphine or fentanyl relieved pain till death due to cancer. Supraspinal side effects of opioids were only seen during the first week of intrathecal narcotic treatment. No serious complications like meningitis or other infections were observed. Postmortem examination also could not detect changes of the cord or signs of arachnoiditis due to intrathecal narcotics or the implanted catheter. We conclude, that continuous intrathecal narcotic infusion by means of small portable pump is a very efficient method to control terminal cancer pain and enables treatment on an outpatient basis until death.

Adult↗
PubMed1988

[Initial experiences with propofol (Disoprivan) for anesthesia induction in pediatric anesthesia].

Propofol is a new intravenous anesthetic agent that provides smooth and rapid induction of anesthesia. A short elimination half-life guarantees rapid recovery. Since it has been reformulated as an emulsion in soya bean oil, anaphylactoid reactions are unlikely to occur. As compared to adults, there is very little experience with propofol in pediatric anesthesia. The aim of this study was to evaluate propofol as an induction agent in children with respect to cardiovascular and respiratory effects and to investigate the incidence of other side-effects. METHOD. In 25 ASA I children aged 3-12 years (6.4 +/- 2.7 SD) anesthesia was induced with a single dose of propofol, after standard premedication with atropine 0.01 mg/kg and Thalamonal 0.04 ml/kg. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured before and each minute for 6 min after propofol administration. The incidence of side-effects during induction of anesthesia as well as during recovery and the postoperative period were recorded. RESULTS. Propofol 2.5 mg/kg produced rapid and smooth induction of anesthesia. Mean arterial pressure decreased after 1 min by 14.3% with a maximum of 16.8% after 3 min. HR was influenced differently by propofol; children with initially high HR had a decrease in HR, whereas in children with a low initial rate, HR increased transiently. After 1 min, no further changes occurred. Although no apnea was observed, respiration was shallow and depressed, as indicated by a decrease in SaO2. Two children complained of pain and 4 of discomfort at the site of the injection; 1 of these developed transient phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1987

Effects of a passive venous bypass on cardiovascular and acid-base balance variables during liver transplantations in pigs.

The anhepatic phase of liver transplantation is accompanied by numerous hemodynamic and metabolic sequelae. The effects of a passive venous bypass on cardiovascular and metabolic variables during the anhepatic phase of orthotopic liver grafting was investigated in 15 pigs (group I) and compared with 10 pigs (group II) without a shunt. In a further five pigs (group III), after total vascular exclusion of the liver, an anhepatic state similar to the anhepatic phase of orthotopic liver transplantation was simulated. The resulting cardiovascular effects in group III were measured first without a shunt and afterwards under the conditions of a passive portojugular shunt. During the anhepatic phase, nonshunted animals required 113% more fluid replacement and 122% more sodium bicarbonate, compared to shunted animals, in order to keep pulmonary capillary wedge pressure (PCWP) and pH in the same range. The end-tidal PCO2 decreased twice as much in nonshunted pigs. The MAP dropped from 86 +/- 6 mmHg to 46 +/- 3 mmHg in experiments without a passive venous bypass, compared to a decrease from 88 +/- 5 mmHg to only 69 +/- 4 mmHg when a passive porto-jugular shunt was used. Concomitantly, a compensatory increase of HR, SVR, and PVR was observed, more pronounced in the nonshunted group. Although the survival after experimental orthotopic liver transplantation was identical in both groups, a passive venous bypass is of great benefit during the anhepatic phase of liver transplantation as regards the cardiovascular and metabolic variables.

Acid-Base Equilibrium↗
PubMed1987

Side effects and changes in pulmonary function after fixed dose precurarization with alcuronium, pancuronium or vecuronium.

On hundred and sixty premedicated patients undergoing surgery were assessed for changes in pulmonary function and signs of partial neuromuscular blockade following precurarization with a fixed dose of alcuronium 2 mg, pancuronium 1 mg or vecuronium 1 mg, and the efficacy of the drugs in the prevention of suxamethonium-associated side effects was compared. In this respect, no differences were observed between the three drugs. Pretreatment with alcuronium and pancuronium was followed by small decreases in pulmonary function. Statistically significant changes were seen only when vecuronium 1 mg was used as the fixed-dose precurarization agent.

Adult↗
PubMed1985

[Vecuronium in infants and children: clinical and neuromuscular effects].

The neuromuscular and cardiovascular effects of vecuronium (Norcuron, Organon Teknika) were studied in 58 infants (1 day-10 months) and 65 children (1-6 years) anaesthetized either with halothane or under balanced anaesthesia. After a bolus dose of 70 micrograms/kg vecuronium the time course of neuromuscular blockade was determined using an electromyographic equipment. Onset time (time to maximal effect) was significantly shorter in infants compared with children; 1.4 +/- 0.7 min (min +/- SD) and 2.7 +/- 0.8 min, respectively. In contrast the recovery index (time for 25% to 75% recovery) was longer in infants than in children 18 +/- 6.7 min and 10 +/- 2.3 min, respectively. Repetitive administration of vecuronium, up to five maintenance doses, did not show any cumulative effects in children under balanced anaesthesia. After repetitive administration the recovery index was 12 +/- 1.7 min. Vecuronium (a bolus dose of 80 or 100 micrograms/kg) did not cause any significant change of blood pressure in infants and children anaesthetized either with halothane or by balanced anaesthesia. Infants under balanced anaesthesia showed a significant decrease in heart rate 15 min after administration of vecuronium. In contrast an increase in heart rate could be observed in children under halothane anesthesia, which was not attributed to vecuronium.

Anesthesia↗
PubMed1984

[Cutaneous cerebrospinal fluid fistula associated with secondary puncture of the dura caused by a peridural catheter].

Prolonged liquor fistula following puncture of the subdural space for diagnostic or anaesthetic purposes has been reported repeatedly. These among other factors are held responsible for headache as well as neurological complications in connection with lumbar puncture. In contrast the appearance of an external liquor fistula in the lumbar region is an extremely rare event. Two patients developed a cutaneous liquor fistula after lumbar laminectomy following an inadvertant dural penetration when an epidural steroid injection was performed. The same occurred in a healthy young patient who had undergone several trials to puncture the epidural space for an epidural anaesthesia in a case of emergency cesarean section Our own observation concerns a 62 years old woman who developed a cutaneous cerebrospinal fluid fistula 12 h after the removal of an epidural catheter, which had caused a secondary perforation of the dura.

Anesthesia, Epidural↗
PubMedDate not supplied

Ultrasound imaging of the thoracic epidural space.

BACKGROUND AND OBJECTIVES: In thoracic epidural anesthesia, the "loss of resistance" technique is the standard technique for the identification of the epidural space (EDS), the feedback to the operator is often solely tactile. Our aim was to establish ultrasonography for the prepuncture demonstration of the anatomic structures surrounding the thoracic EDS and to evaluate its precision and imaging quality. METHODS: We examined 20 volunteers. In each participant, the extradural space and the neighboring anatomic landmarks in the intervertebral space Th 5-6 were identified using 2 imaging techniques: magnetic resonance imaging (MRI) and ultrasonography. We compared corresponding images regarding distance measurements and the visibility of anatomic landmarks. RESULTS: The capacity of ultrasound imaging (US) to depict the thoracic EDS was limited. Due to the better overview, MR images were easier to interpret. However, US proved to be of better value than MRI in the depiction of the dura mater. All important landmarks for the puncture of the thoracic EDS could be identified with both techniques. The overall correlation was satisfactory. US depicted the different structures of the thoracic EDS with an acceptable precision (confidence interval, 4.6 to 8.7 mm). CONCLUSIONS: US showed good correlation with MRI, which is a standard imaging technique for the depiction of the spine. We anticipate that prepuncture ultrasonography may facilitate thoracic epidural anesthesia by needle placement.

Adult↗