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Biomedical subjects

M Zenz

Publications and source records attributed to M Zenz.

At least 145 records · Page 8Linked to original sources
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↗
PubMed1983

[Buprenorphine as a postoperative analgesic following halothane anesthesia. Hemodynamic and respiratory effects].

In 10 healthy patients, buprenorphine was given as the postoperative analgesic (dosage: peripheral venous injection of 5 microgram/kg BW) after traumatological interventions in the lower extremities, which had been performed under barbiturate-induced halothane anaesthesia. The haemodynamic investigations revealed that buprenorphine has only a minor effect on the high pressure system. In the area of the pulmonary circulation, there was a significant increase in mean pulmonary artery pressure from 15.9 mm Hg to 17.8 mm Hg (+12%), as well as an increase in pulmonary vascular resistance by 16.5%. These changes were most marked 30 to 60 min after the administration of buprenorphine. When 2-3 1 O2/min were administered, none of the patients had PaO2 values of less than 100 mm Hg. 60 min after the injection, the PaCO2 value increased from 33.7 mm Hg to a maximum of 43.9 mm Hg. In 3 patients, PaCO2 increased to more than 45 mm Hg. All patients with greater increases of PaCO2 also evidenced greater increases in the pulmonary vascular resistance. Altogether the haemodynamic changes after buprenorphine administration following halothane anesthesia were not very distinct. In individual cases, however, there were greater increases in PaCO2. The cause of this could involve the additive effects of premedication and anaesthesia medication, and possibly the pain level as well. Both the increase in pulmonary artery pressure and the increase in total pulmonary vascular resistance in these patients were due to hypercapnia (von Euler-Liljestrand mechanism).

Adolescent↗
PubMed1983

[Continuous plexus anesthesia to improve circulation in peripheral microvascular interventions].

Five patients were demonstrated: one finger replantation, three toe-to-finger transfers and one finger-finger transfer. An axillary plexus catheter was inserted for postoperative sympathetic blockade. This brought about spasmolysis, an increase in the circulation and an increase in the acral systolic blood pressure. Simultaneously an adequate analgesic effect was achieved through the administration of local anaesthesic. The muscle relaxation assisted the immobilisation of the extremity. The improved circulation, the analgesic effect and the suppression of the muscular activity through continuous plexus anaesthesia have a beneficial influence on healing in replanted or transferred digits.

Adolescent↗
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↗
PubMed1981

[Prenalterol (CGP 7760 B), a new cardioselective beta 1-adrenoceptor-agonist (author's transl)].

The haemodynamic effects of the new selective beta 1-receptor-agonist prenalterol were investigated in two groups each of 8 patients. Dosages of 500 microgram/5 min and 100 microgram/1 min were given after direct closure of atrial septal defect under neuroleptanalgesia. Prenalterol 500 microgram/5 min increased cardiac index (37.5%), heart rate (19%), stroke index (16.2%), mean arterial pressure (26.5%) and dp/dtmax (84.5%) significantly. Total systemic resistance, total pulmonary vascular resistance and mean pulmonary pressure remained constant. Filling pressures of both ventricles decreased slightly but significantly. Maximal hemodynamic changes after infusion of 100 microgram/1 min prenalterol were half as great as with 500 microgram/5 min and occurred 3 min earlier. The haemodynamic action of prenalterol was rather long lasting. One hour after cessation of the drug-infusion there were still detectable haemodynamic effects. In contrast to investigations in awake patients there was a greater increase in heart rate, which is referred to influences on the vagal reflex caused by anaesthesia.

Adrenergic beta-Antagonists↗
PubMed1981

[Peridural morphine-analgesia. II. Respiratory depression (author's transl)].

In nine healthy young patients ventilatory CO2-response curves and mouth-occlusion pressure were measured after peridural injection of 5 mg morphine hydrochloride diluted in 10 ml saline solution in the lumbar region. Patients were not premedicated. Prior to measurements lower extremity operations were performed under peridural anaesthesia. Five minutes after peridural morphine injection there was a slight reduction in ventilatory response to increasing CO2 (94.7% +!- 15%), which was even more pronounced one hour later (74.5% +/- 14.7%). Mouth occlusion pressure decreased to 86.7% +/- 27.4% after 5 min to 72.4% +/- 13.4% after 60 min. Changes in the relation of the central stimulus P100 to the resulting flow (VT/Ti) was 96.7% +/- 32.5% after 5 min and 95.0% +/- 31.4% after 60 min. These results demonstrate a central respiratory depression after peridural morphine injection with a consequent reduction in ventilatory CO2-response.

Adult↗
PubMed1981

[Respiratory training with intermittent positive pressure in acute respiratory disturbances (author's transl)].

In a clinical study the applicability and effectiveness of breathing therapy with intermittent positive pressure in cases of incipient or already established pulmonary complications are evaluated. The case material was divided into four groups: 1. Imminent respiratory complications (haemorrhagic shock, flail chest); 2. acute postoperative pulmonary insufficiency in old patients; 3. postoperative alveolar or interstitial pulmonary oedema; 4. postoperative pneumonia. Individual respiratory training succeeded in all patients in significantly improving the arterial blood gases; prolonged artificial ventilation could be dispensed with. The method and its limitations and indications for its use are reviewed.

Abdomen↗
PubMed1981

[A double-blind comparison of epidural buprenorphine and epidural morphine in postoperative pain (author's transl)].

Morphine (5 mg) and buprenorphine (0.15 mg) given by the epidural route were compared in 50 patients recovering from abdominal surgery. Pain relief score, sedation score and clinical measures were evaluated in a double-blind study. Both substances produced thorough analgesia with short latency (2-6 min) of long duration (8-9 h). Side effects were encountered in some morphine cases only, but never therapy had to be discontinued. Total lack of side effects with buprenorphine favours its application in epidural pain relief.

Anesthesia, Epidural↗