Search PubMed⌕ Search

Biomedical subjects

M Zenz

Publications and source records attributed to M Zenz.

At least 127 records · Page 7Linked to original sources
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↗
PubMed1985

Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication.

In a prospective, controlled, randomized study of a prophylaxis for stress bleeding, 100 high-risk patients in an intensive care unit received, on a daily basis, 1 g of sucralfate every four hours, an antacid every two hours, or 2 g of cimetidine intravenously. All patients also received 50 mg of pirenzepine by intravenous infusion each day. 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 than in patients treated with the other agents, but stress bleeding occurred only in patients treated with cimetidine (n = 2) or antacids (n = 2). In the latter two treatment groups, the probability of bleeding correlated with the incidence of pH values below 4. No side effects of sucralfate therapy were observed. The results indicate that prophylactic treatment of stress bleeding with pirenzepine and sucralfate is at least as effective as combined treatment with pirenzepine and cimetidine or antacids.

Adult↗
PubMed1985

[Long-term therapy of cancer pain. A controlled study on buprenorphine].

Sublingual tablets of buprenorphine (Temgesic sublingual) were given in a controlled trial of 41 patients for 2804 patient-days. With a mean starting dose of 1.09 mg and a final dose of 1.53 mg buprenorphine daily there was a good pain-relieving effect. The interval between doses was six to eight hours. The trial did not reveal any direct pointers as to tolerance or addictiveness after long-term intake of the drug. Because of its effectiveness and good duration of action, as well as the absence of negative long-term effects, the drug can be recommended in the long-term management of cancer pain.

Buprenorphine↗
PubMed1985

Epidural opiates: long-term experiences in cancer pain.

Epidural opiates were administered to 139 patients with pain due to malignant diseases via a chronic indwelling catheter inserted percutaneously. So far, 9,716 days of treatment can be evaluated. In 87% of the patients whose pain previously could not be controlled with conventional analgesic approaches, epidural opiates resulted in remarkable pain relief. With a mean daily dose of 15.6 mg morphine (range 2-290 mg) or 0.86 mg buprenorphine (range 0.15-7.2 mg) half of the patients could be treated as outpatients. The mean duration of therapy was 72 days (range 1-700 days), 26 catheters being in place for more than 100 days and one catheter being in place for 510 days. Two severe side-effects (meningitis) were observed, both patients being free of symptoms after catheter removal and antibiotic therapy. Epidural opiates proved to be a valuable method of pain control in terminal illness. The method should be reserved for those patients, for whom oral opiates fail to produce effective pain relief.

Adult↗
PubMed1985

Continuous plexus blockade for improved circulation in microvascular surgery.

Five patients are presented who were fitted with an axillary plexus catheter for postoperative sympathetic blockade: 1 finger replantation, 3 toe-finger transfers, and 1 finger-finger transfer. This catheter caused spasmolysis and an increase in the circulation and in the acral systolic blood pressure. Simultaneously an adequate analgesic effect was achieved through the administration of local anesthetic. The muscle relaxation helped immobilize the extremity. The improved circulation, the analgesic effect, and the suppression of muscular activity through continuous plexus anesthesia help healing in replanted or transferred digits.

Adolescent↗
PubMed1985

[Modified patient positioning in long-term hand surgery intervention by regional anesthesia].

The authors report a modified positioning of patients for long-term handsurgical operations under regional anaesthesia. After equalizing the level of hand- and operating table, the operating table is tilted 10-15 degrees towards the hand-table. The upper limb is abducted only 30-40 degrees and then rotated outwards. This guarantees a comfortable positioning of the patients for a longer period of time.

Anesthesia, Conduction↗
PubMed1984

[Prevention of anaphylactoid reactions using intramuscular promethazine and cimetidine. Studies of a histamine infusion model].

The effect of combined intramuscular premedication with H1 + H2-receptor-antagonists on histamine-induced cardiovascular and cutaneous reactions was studied in 8 volunteers in a randomized placebo-controlled double-blind crossover trial and compared with premedication with H1-receptor antagonist alone and with the histamine-induced effects without premedication. As H1-receptor antagonist the volunteers received 0.5 mg/kg promethazine i.m. 45 min before the start of histamine infusion; as H2-receptor antagonist we used 400 mg cimetidine i.m. 120 min before application of histamine. While the premedication with promethazine alone could prevent histamine-induced tachycardia, fall of blood pressure and cutaneous reactions only partially, these reactions were almost completely prevented by combined premedication. Like intravenous application of H1 + H2-receptor antagonists shortly injected before induction of anesthesia, intramuscular premedication with promethazine and cimetidine can prevent anaphylactoid reactions. In contrast to intravenous application, the latter application is also effective in reducing the risk of acid aspiration syndrome and as a sedative.

Adult↗
PubMed1984

[Spinal opiate analgesia].

The spinal application of opiates is followed by a long-lasting and strong pain relief. This action is based upon the binding of opiates to specific opiate receptors situated in the substantia gelatinosa of the spinal cord. Two possible approaches exist - intrathecally or epidurally. The intrathecal opiate analgesia is combined with a very high incidence of side effects, so that this way cannot be recommended. The epidural opiate analgesia has proven good results with few side effects in the treatment of postoperative pain, pain of multiple rib fractures and other thoracic trauma or cancer pain. In obstetrics analgesia by spinal opiates was disappointing. Mode of action, possible side effects and the results of epidural opiates are discussed.

Epidural Space↗
PubMed1983

[Effectiveness of cimetidine in the prevention of aspiration pneumonia in obstetrics].

In a prospective controlled study 30 parturients provided for elective cesarean section were premedicated either with no specific medication for prophylaxis of aspiration pneumonia or 400 mg cimetidine orally at the evening and 400 mg intramuscularly two hours prior to induction of anesthesia. In the cimetidine treated group only one patient had a gastric pH below 2.5, while in the control group 11 patients had a pH below this limit. The gastric volume in the cimetidine treated group also was significantly reduced. No side effects could be observed in mothers and children. Application of intramuscularly cimetidine seems to be an effective method for prophylaxis of aspiration pneumonia in obstetric anesthesia.

Anesthesia, Obstetrical↗
PubMed1983

[Sublingual buprenorphine tablets: initial clinical experiences in long-term therapy of cancer pain].

Buprenorphine sublingual tablets (0.2 mg) were investigated in therapy of cancer pain. In 67 patients there was a good analgetic effect in 60%, even in those cases treated with other opiates before. The induction time was quite long (60 min.) but is no problem in chronic administration. Effective pain relief was obtained even in final stages of cancer. The mean daily dose of buprenorphine had been 1.2-1.7 mg, the mean duration of analgesia being 6-8 hours with a single dose of 0.2-1.0 mg buprenorphine. Typical opiate-side-effects were registered and well tolerated after some days' treatment. There was no respiratory depression. Buprenorphine sublingual tablets are certainly a good alternative in orally available opioids.

Administration, Oral↗
PubMed1983

Prolonged analgesia after cuff release following i.v. regional analgesia with prilocaine.

In a prospective randomized study, 60 outpatients received 0.8%, 1.5% or 2% prilocaine (4 mg/kg body weight) as i.v. regional anaesthesia for operations in the carpal region. The latent period, quality and duration of analgesia after release of the tourniquet were analysed. The latent period was shortest with 2% prilocaine. The duration of analgesia after tourniquet release increased from 5.7 min with 0.8% to 15.6 min with 2% prilocaine. The plasma concentrations after 1.5% prilocaine were significantly less than with 0.8% prilocaine.

Analgesia↗
PubMed1983

Rectal and oral cimetidine for prophylaxis of aspiration pneumonitis in paediatric anaesthesia.

In a prospective randomized study, 60 children between 1 and 8 years of age in three groups received no premedication, 10 mg kg-1 cimetidine orally or 40 mg kg-1 cimetidine rectally for prophylaxis of acid aspiration syndrome 120-180 min before induction of anaesthesia. The pH of the stomach contents was above 2.5 in both cimetidine groups. The aspirated gastric volume was significantly reduced with rectal cimetidine compared to the other groups. Rectal cimetidine proved to be the more effective drug for prophylaxis of acid aspiration syndrome in paediatric anaesthesia.

Administration, Oral↗
PubMed1983

[Buprenorphine and pentazocine for postoperative analgesia. A double blind study following abdominal surgery].

A randomized double-blind study was done to test the two opiates buprenorphine (0.3 mg i.v.) and pentazocine (30 mg i.v.) with regard to their applicability for the postoperative phase. These substances were chosen because they are not subject to drug prescription regulations. 60 patients who had undergone epigastric and hypogastric interventions under thiopental-sodium-induced halothane anesthesia received i.v. injections of one of the two analgetics as soon as they requested a pain-killer postoperatively. The subjective pain intensity registered by means of a visual analogue scale shows a gradual decrease after buprenorphine with maximal effects 1-3 h post injectionem (7.3 leads to 1.5). The duration of action is 8.2 +/- 0.7 h on the average (median 8 h; range 4-22 h). The maximal analgetic effect of pentazocine is already attained after 10 min (6.3 leads to 3.2). Thereafter the pain-intensity curve rises again. Pentazocine has a mean duration of action of 2.35 +/- 0.24 h (median 2 h; range 0.5-5 h). The inadequate analgetic effect of pentazocine manifests itself in an only slight initial reduction of the respiratory rate (19.5 leads to 17.5 min-1), which, on the other hand, decreases significantly and continuously under buprenorphine (20.8 leads to 13.5 min-1). Both substances cause increases of PaCO2 (buprenorphine 37.3 leads to 46.8 mmHg; pentazocine 36.3 leads to 43.0 mmHg), values greater than 50 mmHg being attained in individual cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
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

[Use of oral morphine in incurable pain].

Oral morphine sulphate is the strong narcotic of choice at most hospices. Administered in simple aqueous solution (e.g. 10 mg in 10 ml). No advantage in giving as "Brompton Cocktail." Usual starting dose 10 mg every 4 h. If patient has previously only had a weak narcotic analgesic, 5 mg may be adequate. If changing to morphine from alternative strong narcotic, such as dextromoramide, levorphanol, methadone, a considerably higher dose may be needed. With frail elderly patients, it may be wise to start on sub-optimal dose in order to reduce likelihood of initial drowsiness and unsteadiness. Adjust upwards after first dose if not more effective than previous medication. Adjust after 24 h "if pain not 90% controlled." Most patients are satisfactorily controlled on dose of between 5 and 30 mg 4 hourly; however, some patients need higher doses, occasionally up to 500 mg. Giving a larger dose at bedtime (1,5 or 2 x daytime dose) may enable a patient to go through the night without waking in pain. Use co-analgesic medication as appropriate. Eigher prescribe an antiemetic concurrently or supply (in anticipation) for regular use should nausea or vomiting develop. Prescribe laxative. Adjust dose according to response. Suppositories may be necessary. Unless carefully monitored, constipation may be more difficult to control than the pain. Write out regimen in detail with times to be taken, names of drugs and amounts to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.

Administration, Oral↗