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Biomedical subjects

M Tryba

Publications and source records attributed to M Tryba.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Hemostatic requirements for the performance of regional anesthesia. Workshop on hemostatic problems in regional anesthesia].

There is uncertainty as to which preoperative examinations are necessary before performing regional anesthesia. Therefore an interdisciplinary consensus conference was established to obtain recommendations on some of the open questions related to this topic. Preoperative laboratory examinations are not necessary prior to peripheral nerve blocks near large vessels if these are easy to compress. In patients on anticoagulant therapy direct puncture of the vessel should be avoided. Prior to spinal or epidural anesthesia, no preoperative laboratory examinations are necessary if no anamnestic or clinical evidence of coagulation disorders exists. Otherwise the following examinations are useful: clotting time, prothrombin time, partial thromboplastin time (PTT), and thrombocyte count. Low-dose heparin prophylaxis is no contraindication to spinal or epidural anesthesia. However, in patients at increased risk of bleeding or with low body weight, PTT and thrombocyte count are necessary. Since at present no definite data exist as to the bleeding risk in patients treated with low-molecular-weight heparin prophylaxis, spinal/epidural anesthesia should be performed in controlled studies only under these conditions. This particular precaution seems to be necessary because low-molecular-weight heparin increases levels of plasminogen activators (t-PA) and therefore has fibrinolytic activity. If plasma expanders are administered perioperatively, the highest bleeding risk exists after dextran infusions. There is also an increased bleeding risk if nonsteroidal anti-inflammatory drugs, especially acetylsalicylic acid, are administered repeatedly within 5 days prior to spinal/epidural anesthesia. In these patients preoperative determination of the clotting time appears necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Conduction↗
PubMed1989

[A new positioning aid for administering axillary plexus anesthesia].

A "plexus-table" is introduced as a new help to place an arm for application of the axillary plexus block. A modified Maquet arm posturing device offers a sufficient big plate, which is adjustable in all planes. The plate is fixed closely to the operation table. A more comfortable placement of the patient's arm is possible, due to the reduction of the externally rotation of the shoulder. The new table can be adapted to patients with restrictions of the movements of the shoulder. For the anaesthetist this results in a good presentation of the axillary region.

Anesthesia, Conduction↗
PubMed1988

[Stress bleeding and postoperative pneumonias in intensive care patients on ranitidine or pirenzepine].

To prevent stress bleeding, 400 postoperative patients in intensive care but not expected to need long-term mechanical ventilation, were randomly given either 50 mg pirenzepine or 200 mg ranitidine daily intravenously for a mean of 3.9 days. Macroscopically visible bleeding was the criterion of stress bleeding. In addition, special attention was also paid to any signs of pneumonia. There was a significantly higher incidence of gastric pH values of less than 4 in the pirenzepine patients. Six episodes of bleeding occurred in the ranitidine group vs. three in the other. There was a significantly higher incidence of pneumonia among ventilated patients (18.0% vs. 2.7%). Among ventilated patients the pneumonia rate under ranitidine was 28.6% vs. 9.1% in the pirenzepine group (P less than 0.05). The probable cause of the higher pneumonia rate under ranitidine was the gastric colonization with gramnegative organisms. Pirenzepine assures an effective prophylaxis against stress bleeding at least as good as ranitidine. At the same time, the risk of lung infection is also lower with pirenzepine than ranitidine.

Clinical Trials as Topic↗
PubMed1988

Prevention of stress bleeding with ranitidine or pirenzepine and the risk of pneumonia.

In a prospective, controlled, randomized trial of stress bleeding prophylaxis, 400 patients in a surgical intensive care unit received 50 mg pirenzepine (n = 200) or 200 mg ranitidine (n = 200) daily. The drugs were administered continuously via an intravenous line. The mean duration of the treatment was 3.9 days. Patients were included in the study if no long-term ventilation was expected. In patients with a stomach tube in place, the intragastric pH was determined every eight hours. Bleeding was defined as macroscopically visible. Along with stress bleeding, the development of postoperative pneumonia was documented. The intragastric pH was less than 4 significantly more often in patients treated with pirenzepine. In patients treated with ranitidine, six stress bleedings were observed, while in the pirenzepine group three bleeding episodes occurred. Seven of the nine bleeding patients were found to have a very high bleeding risk. In mechanically ventilated patients, a significantly higher risk of pneumonia was observed compared with non-ventilated patients (18.0% vs 2.7%). Fourteen of the 20 pneumonias occurred in patients treated with ranitidine. In ventilated patients treated with ranitidine, the pneumonia rate was 28.6%, while in the pirenzepine group the pneumonia rate reached only 9.1% (p less than 0.05). The increased frequency of pneumonia in patients treated with ranitidine appears to be caused by overgrowth of gram-negative bacteria in the stomach. Pirenzepine provides adequate protection against stress bleeding while also minimizing the danger of pneumonia caused by infection via the gastropulmonary route.

Adult↗
PubMed1988

The use of roxatidine acetate in fasting patients prior to induction of anaesthesia as prophylaxis against the acid aspiration syndrome.

Aspiration pneumonitis is one of the major causes of anaesthesia related deaths. H2-receptor antagonists are effective drugs for the prevention of the acid aspiration syndrome (Mendelson's syndrome). The new long-acting H2-receptor antagonist roxatidine acetate may be the first H2-receptor antagonist which could effectively reduce acid secretion following a single bedtime premedication on the evening before an operation. A prospective controlled randomised double-blind study was conducted in 60 elective patients undergoing gynaecological operations requiring tracheal intubation. 30 patients received oral roxatidine acetate 150 mg at 10 pm, the other 30 patients received placebo. Immediately after intubation, at 15 minutes and at the end of the operation gastric pH and the volume of the aspirate were measured. In the placebo group, 13 patients (43%) had gastric pH values below the critical value of 2.5, while in the roxatidine acetate group gastric pH values were raised above 2.5 in all but 3 patients (10%) [p less than 0.05]. In the roxatidine acetate group pH values were significantly higher than in the placebo group (p less than 0.01). The mean gastric volume in the placebo group was 23.3 +/- 27.1 ml, compared to 14.5 +/- 9.4 ml for roxatidine acetate. The 5 highest gastric volumes were observed in the placebo group (max 146 ml). A single bedtime oral premedication with roxatidine acetate 150 mg ensures a gastric pH above 2.5 until 11 am the following day.

Adult↗
PubMed1988

Penetration of roxatidine into the cerebrospinal fluid.

Central nervous system side effects are occasionally associated with the administration of H2-receptor antagonists. There seems to be a direct correlation between the occurrence of side effects such as mental confusion and the drug concentration in the cerebrospinal fluid. In animal experiments the new H2-blocker roxatidine did not cross the blood-brain barrier. We therefore investigated the penetration of roxatidine into human cerebrospinal fluid (CSF). Nine healthy subjects scheduled for elective spinal anesthesia were premedicated with 150 mg roxatidine orally. Blood samples were taken at 30-min intervals for up to 6 h. A 2-ml CSF sample was taken from each patient at the time of spinal puncture. Small amounts of roxatidine were detectable in the CSF, the CSF to plasma ratio ranging from 0 to 0.89.

Animals↗
PubMed1988

[Cardiovascular reactions and histamine release following atracurium--a problem of dosage?].

All muscle relaxants can induce allergic or pseudo-allergic reactions. The medium-long-acting, nondepolarizing muscle relaxant atracurium has been shown to be a potent histamine liberator. Up to now it is unknown if a clinical dosage of atracurium exists where no clinically relevant histamine release occurs. In a prospectively controlled study we therefore investigated the effects of different dosages of atracurium on cardiovascular reactions and histamine release.

Adult↗
PubMed1988

[Clinical effectiveness and systemic toxicity of various mixtures of prilocaine and bupivacaine in axillary plexus block].

The presently existing local anesthetics (LA) do not guarantee a rapid onset and simultaneously a long duration of action. The combination of a medium-long acting LA with bupivacaine, a long-acting LA with slow onset, could be means to achieve these aims. Prilocaine was chosen as the medium-long acting LA because it has the lowest toxicity of this group and for pharmacological reasons. METHODS. In a prospective, controlled double-blind study 100 patients scheduled for axillary block for elective surgical procedures of the hand or wrist were randomly assigned to five groups. Twenty patients in each group received either 40 ml prilocaine 1.5%; 40 ml bupivacaine 0.375%; 20 ml prilocaine 1% + 20 ml bupivacaine 0.5%; 20 ml prilocaine 2% + 20 ml bupivacaine 0.5%; or 20 ml prilocaine 2% + 20 ml bupivacaine 0.375%. The LA mixtures were freshly mixed 15 min prior to the axillary block. The blocks were performed using an immobile, short-beveled needle by anesthesiologists who were familiar with this technique. Analgesia was classified using the pin-prick method with 0 = no analgesia, 1 = analgesia, 2 = anesthesia. Motor blockade was classified with 0 = no motor block, 1 = paresis, 2 = paralysis. The following nerves were analyzed: ulnar, radial, median, musculocutaneous, and medial antebrachial. In 6 patients of each group plasma levels of the LA were measured by gas chromatography and methemoglobinemia was determined. Statistical analysis of the data was performed using the Student t-test and chi-square test on a level of significance of P less than 0.05. Results. All surgical procedures could be performed as planned in regional anesthesia. Twenty minutes after injection of the LA only 15% of the blocks were sufficient in the bupivacaine group, while in the other four groups 40%-50% of the blocks were complete (P less than 0.05). The degree of analgesia was deeper in the groups with 2% prilocaine and prilocaine alone than in the group with 1% prilocaine. Forty minutes after injection there were no significant differences between the groups. Motor blockade after 20 min was significantly lower in the bupivacaine group than in the prilocaine group (P less than 0.05). After 4 h all three prilocaine-bupivacaine mixtures showed a significantly more pronounced analgesia of the median nerve than the prilocaine group (P less than 0.02-0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids.

In a prospective, controlled, randomized study of the prophylaxis of stress bleeding, 100 ventilated high-risk patients in a surgical intensive care unit received, on a daily basis, 1 g of sucralfate suspension (n = 50) every four hours, or an antacid (n = 50) every two hours. The mean duration of the treatment was about six days in both of the groups. Gastric pH was determined every eight hours. Bleeding was defined as macroscopically visible bleeding. The intragastric pH was less than 4 significantly more often in patients treated with sucralfate. In each group, one case of macroscopically visible bleeding occurred. Both of the patients had a very high risk of bleeding. None of the bleedings influenced the outcome of the patients. When patients with primary thoracic trauma or pneumonia were excluded, nosocomial pneumonia developed in significantly fewer (p less than 0.05) patients in the sucralfate group (three of 29) than in the antacid group (11 of 32). In four of the latter patients, pneumonia influenced the outcome of the patients. Sucralfate provides adequate protection against stress bleeding while also minimizing the danger of pneumonia caused by infection via the gastropulmonary route.

Adult↗
PubMed1987

Antibacterial activity of sucralfate in human gastric juice.

A series of experiments was conducted to determine the rate of bacterial growth in human gastric juice at various pH values in relation to the addition of sucralfate and antacid. Whereas the addition of antacid resulted in bacterial growth in gastric juice, sucralfate showed an antibacterial effect. This may account for the decreased rate of pneumonia among intensive-care patients who are receiving artificial ventilation and being treated with sucralfate for the prevention of stress-induced gastrointestinal bleeding compared with the rate in patients receiving conventional prophylaxis with histamine (H2)-antagonists or antacids.

Aluminum Hydroxide↗
PubMed1987

[Therapy of perioperative sinus tachycardia with the new calcium antagonist falipamil].

The haemodynamic responses after application of 100-200 mg falipamil (5,6-dimethoxy-2-(3-((alpha (3,4-dimethoxy)-phenylethyl) methylamino)propyl)phthalimidine, AQ-A 39) a new calcium channel blocker with specific action on the sinus node, was studied in 11 patients with perioperative sinus tachycardia (greater than 120/min). A drop in the heart rate of at least 10% could be observed in all patients. In 8 patients 100 mg falipamil decreased the mean heart rate from 130 +/- 19 to 97 +/- 8/min 5 min after the application (p less than 0.001). In the resting 3 patients a second dose of falipamil was injected because of insufficient clinical response. In these patients the mean heart rate dropped from 162 +/- 27 to 125 +/- 40/min 10 min after the second dose. No significant changes of the blood pressure could be observed. Falipamil may become a valuable drug for the therapy of sinus tachycardia due to catecholamines during the perioperative period.

Adult↗
PubMed1987

[Clinical and toxicologic study of axillary plexus block with prilocaine or mepivacaine].

A prospective controlled double-blind study was designed to compare the efficacy and the toxicity of mepivacaine and prilocaine for the axillary blockade of the brachial plexus. Twenty patients in each group received 40 ml of either 1.5% mepivacaine or 1.5% prilocaine. The sensory and the motor blockade achieved in both groups were comparable. The mean plasma levels attained following mepivacaine were significantly higher than those attained after prilocaine (peak-plasma level (mean +/- SD): 2.02 +/- 0.28 micrograms/ml vs 5.37 +/- 1.83 micrograms/ml). In four patients of the mepivacaine group, the plasma levels entered the toxic range. While no methemoglobinemia could be detected following mepivacaine, four of the patients receiving prilocaine developed methemoglobinemia with a maximum level of 10%. No complications due to methemoglobinemia were observed in any of the patients. Because of its significantly lower toxic potential, prilocaine seems to be the better local anaesthetic for axillary blockade of the brachial plexus.

Adult↗
PubMed1986

Prevention of histamine-induced cardiovascular reactions during the induction of anaesthesia following premedication with H1- + H2-antagonists i.m.

In a prospective controlled double-blind study, 60 elective surgical patients were randomly assigned to three premedication groups. Twenty patients received promethazine 0.5 mg kg-1 i.m. 45 min before induction of anaesthesia; a further 20 patients received an additional i.m. injection of cimetidine 400 mg 120 min before induction. The third group (n = 20) served as the control group. Following vecuronium 0.02 mg kg-1, anaesthesia was induced with fentanyl, and etomidate. All patients then received suxamethonium 1.5 mg kg-1 i.v. The combined administration of H1- + H2-antagonists as premedication led to a significant reduction in the increase in heart rate when compared with the effects in the other groups.

Adult↗
PubMed1986

[Sympathetic block after plexus anesthesia. Comparison with stellate ganglion block].

Plethysmographic measurements of the upper extremity were performed in ten patients after axillary plexus block and in eight patients after stellate ganglion block. Axillary plexus block was followed by a mean increase of 396% in arterial blood flow. After stellate ganglion block, the arterial blood flow increased by 232% (P less than or equal to 0.001) compared to the pre-block value. There was no change in venous capacity after either method. The results indicate that both blocks can alternatively be used, as they have the same effects regarding increased arterial flow and stable venous capacity.

Adult↗
PubMed1986

[Vecuronium in crash intubation].

A prospective controlled study was conducted to compare the efficacy of vecuronium and succinylcholine for the crash-induction technique. Following precurarisation with 0.02 mg/kg vecuronium and 0.1 mg fentanyl (group A and B) or NaCl 0.9% and 0.1 mg fentanyl (group C) preoxygenation via face mask was maintained until the patients reported heavy eye-lids or weariness or the precurarization-time attained 120 s. The patients then received 5 mg/kg thiopentone followed by 1.5 mg/kg succinylcholine (group B) or 0.08 mg/kg vecuronium (group A) resp. 0.1 mg/kg vecuronium (group C) directly before the thiopentone. Rapid intubation and scoring of the intubation condition was performed by an anaesthetist who was unaware of the grouping. The intubation time was defined as the interval from the end of the injection of the drugs until cuff-inflation of the tracheal tube. All patients in group A and B could be intubated within 60 s, in contrast to only 15 patients in group C (p less than 0.05). The intubation conditions in the succinylcholine group and in the vecuronium group with divided doses showed no significant differences, while in group C the conditions were significantly worse. The modified crash-induction technique with vecuronium in divided doses could become beneficial in patients with contraindications of the use of succinylcholine who are at risk of aspiration.

Anesthesia↗