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Biomedical subjects

P Hügler

Publications and source records attributed to P Hügler.

7 recordsLinked to original sources
PubMed2003

Desflurane compared with propofol for postoperative sedation in the intensive care unit.

BACKGROUND: We hypothesized that emergence from sedation in postoperative patients in the intensive care unit would be faster and more predictable after sedation with desflurane than with propofol. METHODS: Sixty patients after major operations were allocated randomly to receive either desflurane or propofol. The target level of sedation was defined by a bispectral index(TM) (BIS(TM)) of 60. All patients were receiving mechanical ventilation of the lungs for 10.6 (SD 5.5) h depending on their clinical state. The study drugs were stopped abruptly in a calm atmosphere with the fresh gas flow set to 6 litres min(-1), and the time until the BIS increased above 75 was measured (t(BIS75), the main objective measure). After extubation of the trachea, when the patients could state their birth date, they were asked to memorize five words. RESULTS: Emergence times were shorter (P<0.001) after desflurane than after propofol (25th, 50th and 75th percentiles): t(BIS75), 3.0, 4.5 and 5.8 vs 5.2, 7.7 and 10.3 min; time to first response, 3.7, 5.0 and 5.7 vs 6.9, 8.6 and 10.7 min; time to eyes open, 4.7, 5.7 and 8.0 vs 7.3, 10.5 and 20.8 min; time to squeeze hand, 5.1, 6.5 and 10.2 vs 9.2, 11.1 and 21.1 min; time to tracheal extubation, 5.8, 7.7 and 10.0 vs 9.7, 13.5 and 18.9 min; time to saying their birth date, 7.7, 10.5 and 15.5 vs 13.0, 19.4 and 31.8 min. Patients who received desflurane recalled significantly more of the five words. We did not observe major side-effects and there were no haemodynamic or laboratory changes except for a more marked increase in systolic blood pressure after stopping desflurane. Using a low fresh gas flow (air/oxygen 1 litre min(-1)), pure drug costs were lower for desflurane than for propofol (95 vs 171 Euros day(-1)). CONCLUSIONS: We found shorter and more predictable emergence times and quicker mental recovery after short-term postoperative sedation with desflurane compared with propofol. Desflurane allows precise timing of extubation, shortening the time during which the patient needs very close attention.

Adult↗
PubMed1997

Intracutaneous histamine injection can detect damage of cutaneous afferent fibres in postherpetic neuralgia.

BACKGROUND: The axon reflex response in diseased skin of patients with postherpetic neuralgia may be significantly impaired. OBJECTIVE: In the present study we introduced a simple test for quantifying the decreased axon reflex flare response in the clinical routine. METHODS: Histamine was intradermally applied to the diseased dermatome as well as to the corresponding dermatome of the contralateral side of the body. Ten minutes after application, skin blood flow and the extension of the hyperaemic response were assessed by means of laser Doppler scanning. RESULTS: In the skin region affected by the postherpetic neuralgia, the hyperaemic area was significantly smaller than in the healthy skin. The mean flux values did not differ significantly between the two sites. There was no correlation between the hyperaemic response and the intensity of pain sensation assessed by a clinical visual analogue score. CONCLUSION: The smaller hyperaemic area in the dermatome with postherpetic neuralgia strongly indicates a C fibre or C nociceptor damage. We consider histamine injections as a useful tool in the differential diagnosis of postherpetic neuralgia.

Aged↗
PubMed1992

[Therapy of post-herpetic neuralgia. Pain therapy using an anti-varicella zoster immunoglobulin].

After remission of the dermatological symptoms of herpes zoster infection, post-zoster neuralgia (PZN) can persist or recur for months and years. Most frequently, satisfactory therapy of PZN is not possible. During recent years the persistence of viruses on the surface of neuronal cells has been discussed as the possible reason for chronic pain. Virostatic therapy as well as polyvalent 7s-IgG-immunoglobulins exerted a minimal effect on the pain level. In an open trial we therefore used a specific anti-varicella zoster immunoglobulin (VZI) for treatment of PZN. METHODS. In our study ten patients (six female, four male; age 55-87 years) with latencies between the acute infection and onset of immunoglobulin therapy between 10 months and 3 years were included. PZN was located according to the dermatomes involved: one trigeminal nerve, one cervical, four thoracic and four lumbal segments. All patients had received more than two different drugs or had had therapeutic procedures without success. On the visual analogue scale (VAS: 0-100%) all patients rated their subjective pain with at least 49%. Before starting the study the preexisting specific drug therapy was discontinued in all patients. VZI infusion was given i.v. at a dose of 2 ml/kg body weight within 120 min. All patients had to rate their pain at the VAS every 10 min during the 120 min infusion time, at day 1, 2, 7, 14, 30 and than every month after therapy with VZI. RESULTS. Even during the infusion all ten patients reported a sharp decrease in pain of at least 47% (average 87%) on the VAS. Fourteen days later the remaining pain level averaged 6% VAS. Only the first of the 10 patients reported twice a recurring increase of pain. He therefore received the standard dosage of VZI again at day 2 and day 214, respectively. Thereafter until day 566 the pain level of this patient was lower than 10% VAS. The maximum surveillance interval has so far been 600 days. No side-effects due to the infusion of VZI have been encountered. CONCLUSIONS. Treating pain in persistent PZN is extremely difficult and mostly results in a small diminution of the pain level. Persistence of viruses on the neuronal cell surface and resulting reduction of "luxury functions" of those cells may explain algogenesis by PZN and resistance to therapeutic efforts. We used VZI for the first time for therapy of PZN and observed a striking analgesic effect in all patients for the entire surveillance time.

Aged↗
PubMed1991

[Important laboratory parameters of deep frozen coagulation active fresh plasma and virus inactivated lyophilized pool plasma].

Fresh Frozen Plasma is the most important therapeutic agent in acquired coagulation disorders. We investigated the quality of a new virus-inactivated lyophilisated human pool-plasma (VFL) and conventional fresh frozen plasma (FFP). In VFL we found a significantly reduced coagulation activity, a significantly higher pH-value, a highly significant rise of heparin values and a significantly lower number of thrombocytes. Electrolytes, protein levels and complement activity showed no significant difference. In conclusion, this virus-inactivated lyophilisated human pool plasma does not seem to be susceptible to therapy coagulation disorders like the conventional fresh frozen plasma.

Antiviral Agents↗
PubMed1991

[Quality control studies of 3 deep-frozen coagulation-active fresh frozen plasma preparations from various suppliers and a new virus-inactivated lyophilized pooled plasma preparation].

Fresh frozen plasma is the most important therapeutic agent in acquired coagulation disorders. We investigated the quality of three conventional fresh-frozen plasma preparations (groups I, II, IV) and one new virus-inactivated lyophilised pooled plasma preparation (group III). In the new plasma preparation we found a significant reduction in coagulation activity, a significantly higher pH value and a highly significant rise in plasma heparin levels. No significant difference in electrolytes, protein levels and concentration or complement activity was found in any of the groups. In conclusion, unlike conventional fresh-frozen plasma, this new virus-inactivated lyophilised pooled plasma preparation does not seem to be suitable for use in therapy of coagulation disorders.

Antiviral Agents↗