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Biomedical subjects

M Kirschbaum

Publications and source records attributed to M Kirschbaum.

35 records · Page 2Linked to original sources
PubMed1990

[Maternal and neonatal plasma concentrations of bupivacaine during peridural anesthesia for cesarean section].

Many anesthesiologists prefer epidural anesthesia for cesarean section because of the potential risks of general anesthesia such as Mendelson's syndrome. For this indication, the local anesthetic of first choice is the long-acting substance bupivacaine. The aim of the following study was to determine maternal and neonatal plasma concentrations of bupivacaine 0.5% following epidural anesthesia for cesarean section in order to give critical statements about the systemic toxicity of the local anesthetic. MATERIALS and METHODS. Central venous blood samples were collected for bupivacaine analysis (gas chromatography) in 15 patients (Table 1) undergoing cesarean section with epidural anesthesia over a period of 60 min after injection of 14 to 23 ml bupivacaine 0.5%. Six of these patients had received the epidural anesthesia earlier to relieve labor pain. Before administering the anesthetic dose, a blood sample was taken to determine the baseline value. Immediately after cord clamping, blood sampling was done to determine bupivacaine concentrations in the umbilical artery and vein. Apgar scores and blood gases were also checked and compared with those of neonates born by cesarean section under general anesthesia. RESULTS. Ten to 15 min following epidural application of 70 to 115 mg bupivacaine (mean = 99 mg), peak plasma concentrations occurred (mean = 0.41 micrograms/ml) The maximum plasma level of 0.7 micrograms/ml bupivacaine was found in a patient who had received epidural anesthesia for pain relief during labor. In this case, the baseline bupivacaine level after several epidural injections (125 mg in 15 h) before the anesthetic dose for cesarean section was 0.2 micrograms/ml. Immediately after delivery the mean plasma bupivacaine concentrations in the umbilical vein and artery were 0.11 micrograms/ml and 0.07 micrograms/ml respectively. Apgar scores and blood gas analyses showed no significant difference between neonates born by cesarean section under regional or general anesthesia. DISCUSSION. Using bupivacaine 0.5% for epidural anesthesia for cesarean section, we found maternal and neonatal plasma concentrations of the local anesthetic far below the accepted threshold level for producing systemic toxic reactions. In contrast to others, we obtained good analgesia and sufficient motor blockade accompanied by low plasma levels. In our opinion, there is no need to use 0.75% bupivacaine, especially since peak plasma concentrations of more than 2 micrograms/ml occur shortly after its epidural administration.

Adult↗
PubMed1989

[Histologic reactions following implantation of a "lyodura-soft" band--animal experiment studies of an abdomino-vaginal sling operation].

Abdomino-vaginal sling operations are favoured for the treatment of female stress incontinence recidive. An actual material for the sling ribbon is the Lyodura-soft. Histological reactions between one week and one year are described after experimental subcutaneous implantation of the Lyodura-soft ribbon in rats. After the initial inflammatory reaction in the surrounding connective tissue of the graft during the first 1-2 weeks, a capsule of fibre rich connective tissue is produced by the organism. After 6 months to 1 year the capsule has almost vanished. A reduction of the graft has not taken place during that time. The graft has not lost its morphological identity. Graft versus host reactions are not seen. According to our results the exact position of the ribbon has to be emphasized. The connective tissue of the organism has only a transitory effect on the stability of the graft and so on the success of the operation.

Animals↗
PubMed1989

[Does the development of methemoglobin in the newborn infant affect the suitability of prilocaine for pudendal anesthesia? A clinical study in the peripartum phase].

Pudendal block is a well established method of achieving analgesia during the second stage of labor. Whenever a large amount of a local anesthetic has to be injected in well vascularized tissue, local anesthetic drugs with low systemic toxicity should be used, to minimize side effects. This means that prilocaine is the drug of choice. It is well known that the metabolites of prilocaine induce methemoglobinemia, and thus the question arises as to whether the methemoglobinemia affects the fetus. PATIENTS AND METHODS. Pudendal block was achieved with 2 x 10 ml prilocaine 1% in each of 17 mothers. Plasma concentrations of the local anesthetic in the second stage of labor were determined by gas chromatography in blood samples drawn from the mother and the newborn at the moment of childbirth. In addition, the time course of methemoglobinemia was determined by capillary blood samples from the neonate up to 6 h. To evaluate methemoglobinemia in the newborn, 125 microliters heparinized capillary blood was diluted with 200 microliters 0.9% sodium chloride; methemoglobin was detected by absorbance spectrometry. RESULTS. Before the pudendal block maternal methemoglobin concentrations were about 0.2% of the total hemoglobin concentration and within the physiological range. At the moment of delivery it was increased only to a small extent, without statistical significance. In the neonates mean methemoglobin concentrations were about 1% of total hemoglobin immediately after delivery, increasing up to 1.8% in the next 2 h and then decreasing continuously in all. At the moment of childbirth maternal mean prilocaine concentrations were 0.57 micrograms/ml on an average and 0.29 micrograms/ml in the newborn. DISCUSSION. With respect to systemic toxicity, prilocaine is the drug of choice in local anesthetic procedures when a long duration of anesthesia is not required; it guarantees short latency and adequate relief of pain. Methemoglobinemia induced by its metabolites is not a contraindication for its use in humans. Formerly prilocaine was judged to be contraindicated in pregnant women during delivery because of the small redox capacity of fetal erythrocytes. Our study, however, demonstrates that 200 mg prilocaine for pudendal block does not induce methemoglobinemia in newborns to any significant extent. One explanation for this may be the increased renal elimination of local anesthetics in newborns and the low fetomaternal ratio.

Anesthesia, Obstetrical↗
PubMed1988

[Light microscopic investigation of the tissue integration of Lyodura soft implants].

Commercial preparations of human "Lyodura soft" were implanted into the subcutaneous connective tissue of 40 Wistar rats. After survival times from 7 days up to 1 year the samples were examined by light microscopy. An initial reaction of mononuclear cells, activated fibroblasts, and some giant cells of foreign body type in the surrounding connective tissue is followed by the development of a fibrous capsule rarefied by cells around the implant in the time up to 3 months. After 6 months and more clearly after one year the capsule is reduced or even completely vanished. The implant remains then integrated in the subcutaneous connective tissue almost without residual reactions or signs of resorption.

Animals↗
PubMed1985

A somatic component to myocardial infarction.

Sixty two patients were randomised to be seen by osteopathic physicians for palpation of the thoracic paravertebral soft tissue, T1-T8. Twenty five patients had clinically confirmed acute myocardial infarction. Of the remainder, 22 without known cardiovascular disease served as controls and 15 were placed in an excluded group because of diagnosed cardiovascular disease other than myocardial infarction. Observations were described in predetermined standard terminology. The control group was found to have a low incidence of palpable changes throughout the thoracic dorsum, and these changes were uniformly distributed from T1 to T8. Examination of the group with myocardial infarction disclosed a significantly higher incidence of soft tissue changes (increased firmness, warmth, ropiness, oedematous changes, heavy musculature), confined almost entirely to the upper four thoracic levels. The 15 patients who were excluded from the experimental group because they had various cardiovascular diseases other than myocardial infarction also showed significantly different changes on palpation compared with the group with myocardial infarction. These findings suggest that myocardial infarction is accompanied by characteristic paravertebral soft tissue changes which are readily detected by palpation.

Adult↗
PubMed1985

High-dose intravenous immunoglobulin for post-transfusion purpura.

Five patients with post-transfusion purpura (four due to Zw(a), one presumably due to HLA antibodies) were treated with intravenous immunoglobulin (IgG) at doses of 0.4 g per kg body weight. IgG therapy was immediately effective as indicated by cessation of bleeding and rise of platelet counts in four out of five cases.

Adult↗
PubMed1984

[Light and electron microscopic studies on local reactions to implanted collagen hemostypticum--an experimental animal study].

A light and electron microscopic study was made on the resorption of native collagen fleece following its subcutaneous implantation or its application on a bleeding liver surface in 132 Wistar rats. Resorption of collagen began with the immigration of micro- and macrophages. Organisation of subcutaneous connective tissue was seen from day 5 p.o. to day 15 p.o. The excessive connective tissue was removed after 25 days and foreign body granulomas were eliminated after 50 to 100 days. Typical characteristics of application of the collagen fleece on bleeding liver surface are: Rapid hemostasis, mesothelisation of collagen towards the peritoneum after 1 day, resorption and organisation without adhesion after 10 days. The final heeling leads to a smooth thickening of the liver capsula with a few residual granulomas after 100 days.

Absorption↗
PubMed1983

The relationship of carotid sinus stimulation to exercise testing.

This review is an attempt to demonstrate the safety and usefulness of the simple maneuver of carotid sinus stimulation with selected subjects undergoing exercise tests. In a variety of circumstances the addition of CSP before or after treadmill walking can yield clinically relevant information relating to arrhythmias, conduction disturbances, symptoms, and pacemakers. Further applications and benefits of these combined procedures remain to be clarified and expanded for judicious application with attention to safeguards.

Angina Pectoris↗
PubMed1981

Ventricular function before and after mitral valve replacement.

To evaluate right ventricular function following mitral valve replacement, we studied 84 patients with isolated mitral valve disease with the use of first-pass radionuclide angiography before, 1 week after, and up to 1 year after operation. The right ventricular ejection fraction for the entire group improved from 29% +/- 11% to 43% +/- 10% (p less than 0.001) at 1 week. This increase was maintained at 3 months (41% +/- 10%) and up to year after operation (40% +/- 12%). The improvement was found not to be influenced by either the type of valvular lesion or the presence and/or level of pulmonary hypertension. When the patients were grouped according to the type of prosthetic valve placed at operation, the right ventricular ejection fraction increased in all patients within 1 week of operation, with sustained improvement at 3 months postoperatively. Thereafter, it began to decline in patients receiving a Carpentier bioprosthesis while being maintained in those patients who received disc valves. Further analysis revealed that those patients who receiving the larger Carpentier bioprostheses had a greater deterioration of right ventricular function than those receiving the smaller Carpentier valves. Left ventricular function in the entire group was normal preoperatively (62% +/- 16%) and was unchanged at 1 week (60% +/- 16%) and a 1 year (59% +/- 16%) after operation.

Adult↗
PubMedDate not supplied

[The uterine contraction stress test with oxytocin nasal spray in the diagnosis of hypoxemia].

Deceleration of the fetal heart rate are indications of fetal distress, which are commonly seen in connection with uterine contractions. The aim of the investigation was, whether nasal application of oxytocin (Syntocinon, Sandoz AG) is sufficient for the induction of contractions for an oxytocin-challenge-test. 232 oxytocin-challenge-tests in 85 risk patients between 29th-42nd week of gestation were analyzed in a retrospective and prospective way. The amounts of oxytocin nasal spray necessary for stimulating contractions were compared to the gestational age and maternal body weight (1 spray snuff = 4 IU Oxytocin). 20 pregnant women were given 8 IU oxytocin nasal spray after 10 minutes CTG-registration without any contractions. The incidence of induced contractions per ten minutes period were calculated. The amount of oxytocin nasal spray necessary for the stimulation of contractions decreased in relation to the increased gestational age and maternal body weight (oxytocin spray = 2.751-0.051 X (gestational age)-0.014 X (body weight), p less than 0.01). After a single application of 8 IU oxytocin nasal spray at least one contraction occurred in 13 out of 20 cases within the first 10 minutes. Between the 20th-30th minute the induced uterine contractions reached a maximum of 3 contractions per 10 minutes. No persisting contractions were observed. The application of 8 IU of oxytocin nasal spray is sufficient to induce in about 95% of the cases an oxytocin-challenge-test which gives information concerning the actual state of the fetus at risk.

Administration, Intranasal↗