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M Tryba

Publications and source records attributed to M Tryba.

123 records · Page 7Linked to original sources
PubMed1983

Single-drug and combined medication with cimetidine, antacids and pirenzepine in the prophylaxis of acute upper gastrointestinal bleeding.

For an analysis of the risk factors for stress bleeding, 24 risk factors selected from 202 clinical parameters were analysed, and their values determined in 586 medical and surgical intensive-care patients treated for at least six days between 1975 and 1980, who received no prophylactic medication. In 420 patients who received a prophylactic treatment with 800 mg or 1200 mg cimetidine, 2-hourly 30 ml antacids or 30 mg pirenzepine individually or in combination, the total risk scores were determined as the sum of the risk factors. This risk score served as the unit for comparison of the prophylaxis groups. Combined medication with two or three drugs proved to be significantly superior to treatment with either of the medicaments given alone.

Acute Disease↗
PubMed1983

[Efficacy of cimetidine in the prevention of aspiration pneumonia in paediatric anaesthesia].

In a prospective controlled study 63% of 150 children without prophylaxis were at risk of aspiration pneumonia in case of aspiration or regurgitation. In a second trial 10 mg/kg cimetidine orally 120 to 180 minutes prior to induction of anaesthesia proved to be a very effective prophylaxis. In small children up to 15 kg rectal application of 40 mg/kg cimetidine was even more effective than 10 mg/kg orally in reducing gastric volume. Premedication with cimetidine may be a practicable method for reducing the risk of aspiration pneumonia in paediatric anaesthesia.

Adolescent↗
PubMed1983

[Peridural opiate analgesia. Clinical results of a 2-year study].

Postoperative pain relief, consumption of analgesics and the incidence of postoperative complications were investigated in a retrospective cohort-study on 470 patients following abdominal surgery. 221 of these patients received epidural morphine or buprenorphine for postoperative pain relief (Group I). Another group of 249 patients received conventional opiate analgesics intravenously or intramuscularly (Group II). On average the analgesia lasted 14 h after epidural morphine and 11 h after epidural buprenorphine. The overall amount of morphine in the postoperative period was 13.3 +/- 14.9 mg and 0.89 +/- 0.55 mg buprenorphine respectively. 5 cases of pneumonia (2.3%) were seen in the epidural group (Group I). 22 pneumonia cases (8.8%) were registered in the group with conventional analgesics (Group II). Besides the advantage of stronger and longer duration, small dosage and minor central depressive side effects, epidural opiate analgesia has proven to result in positive clinical consequences. The low incidence of postoperative pneumonia is due to the strong regional pain relief, which improves mechanical pulmonary function and gas exchange.

Adult↗
PubMed1983

[Does a stomach tube enhance regurgitation during general anaesthesia?].

The effect of a gastric tube on the competence of the lower esophageal sphincter was studied in 7 patients who underwent gastric resection. In 6 patients the maximal gastric volume until occurrence of regurgitation was lower in the presence of a gastric tube compared with the measurement without a tube. This shows the necessity to remove a gastric tube prior to induction of anaesthesia.

Adult↗
PubMed1983

[Controlled study on intravenous regional anesthesia using high and low concentration prilocaine].

In a prospective randomised study, 20 out-patients in each group received 0.8%, 1.5% or 2% prilocaine (4 mg/kg body weight) as intravenous regional anaesthesia for operations in the carpal region. The latency time, quality of analgesia and recurrence of pain after the tourniquet release rose with increasing prilocaine concentration from 5.7 min on average at 0.8% to 15.6 min on average at 2%. The latency time was shortest with 2% prilocaine. The blood plasma levels using the highly concentrated prilocaine were significantly lower than with 0.8% prilocaine.

Anesthesia, Conduction↗
PubMed1982

[Toxicity of prilocaine and bupivacaine in intravenous regional anesthesia].

In a prospective randomized study plasma levels of prilocaine and bupivacaine were analyzed after intravenous regional analgesia (IVRA). 20 patients respectively received either 1 mg/kg bupivacaine or 4 mg/kg prilocaine in an equipotent dosis. Prilocaine proved to be significantly less toxic than bupivacaine. Plasma levels of bupivacaine, expressed as percentage of the toxic limit, were threefold higher than those of prilocaine. In one case the maximum level of bupivacaine reached even 85% of the toxic limit. This demonstrates the possibility of dangerous side effects when exceeding the bupivacaine dose of 1 mg/kg. Methaemoglobin formation following use of prilocaine was of no clinical importance. Prilocaine is the agent of choice for intravenous regional analgesia. The use of bupivacaine for IVRA should be limited to special indications.

Adult↗
PubMed1982

[Sonographic studies for optimizing the cannulation of the internal jugular vein].

The increasing use of cannulation of the internal jugular vein led to an increase of complications associated with this procedure. In most cases the reason is incorrect puncture. Functional sonographic studies of the internal jugular vein have demonstrated the anatomical conditions for safe cannulation. The optimal site of puncture was detected with a sector scan by measuring volumes in both internal jugular veins in 12 patients dependent on the position and rotation of the head. As a result of our study we propose a modification in the cannulation technique with a headdown position and 45 degrees rotation of the head to the opposite site without palpating the carotid artery.

Catheterization↗
PubMed1982

[Prevention of aspiration pneumonia with cimetidine].

Aspiration of gastric acid is one of the most feared narcosis complications. The currently practiced methods of prophylaxis did not reduce the frequency of aspiration pneumonitis. In a prospective randomised study orally and intramuscularly given Cimetidine significantly reduced the toxicity of stomach contents. The intramuscular route proved to be superior. Preoperative prophylactic use of Cimetidine can be a useful method to reduce the frequency of Mendelson's syndrome without disadvantages.

Administration, Oral↗
PubMedDate not supplied

Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses.

PURPOSE: To resolve discrepancies in previous systematic overviews and provide estimates of the effect of stress ulcer prophylaxis on gastrointestinal bleeding, pneumonia, and mortality in critically ill patients. DATA IDENTIFICATION: Computerized search of published and unpublished research, bibliographies, pharmaceutical and personal files, and conference abstract reports. STUDY SELECTION: Independent review of 269 articles identified 63 relevant randomized trials for inclusion. DATA ABSTRACTION: We made independent, duplicate assessment of the methodologic quality, population, intervention, and outcomes of each trial. RESULTS: The source of discrepancies between prior meta-analyses included incomplete identification of relevant studies, differential inclusion of non-English language and nonrandomized trials, different definitions of bleeding, provision of additional information through direct correspondence with authors, and different statistical methods. The current overview demonstrates that prophylaxis with histamine2-receptor antagonists decreases the incidence of overt gastrointestinal bleeding (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.42 to 0.79) and clinically important bleeding (OR, 0.44; 95% CI, 0.22 to 0.88). There is a trend toward decreased overt bleeding when antacids are compared with no therapy (OR, 0.66; 95% CI, 0.37 to 1.17). Histamine2-receptor antagonists and antacids are associated with a trend toward lower clinically important bleeding rates than sucralfate is. There is a trend toward an increased risk of pneumonia associated with histamine2-receptor antagonists as compared with no prophylaxis (OR, 1.25; 95% CI, 0.78 to 2.00). Sucralfate is associated with a lower incidence of nosocomial pneumonia when compared with antacids (OR, 0.80; 95% CI, 0.56 to 1.15) and histamine2-receptor antagonists (OR, 0.77; 95% CI, 0.60 to 1.01). Sucralfate is also associated with a reduced mortality rate (OR, 0.73; 95% CI, 0.54 to 0.97) relative to antacids and to histamine2-receptor antagonists (OR, 0.83; 95% CI, 0.63 to 1.09). CONCLUSIONS: Our results emphasize the need for registries to include all randomized trials and demonstrate the importance of explicit methodology for systematic reviews. There is strong evidence of reduced clinically important gastrointestinal bleeding with histamine2-receptor antagonists. Sucralfate may be as effective in reducing bleeding as gastric pH-altering drugs and is associated with lower rates of pneumonia and mortality. However, the data are insufficient to determine the net effect of sucralfate compared with no prophylaxis.

Antacids↗