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Biomedical subjects

S Chrubasik

Publications and source records attributed to S Chrubasik.

54 records · Page 3Linked to original sources
PubMed1995

[Early detection of opiate-induced respiratory depression in the postoperative phase].

We examined in 30 patients the efficacy of regular assessments of respiratory rate (every 15 minutes) and blood gas analysis (at 30, 60, 120, 180 minutes) and continuous monitoring via pulsoximeter and capnometer in recognizing early ventilatory problems. For postoperative analgesia the patients received randomly and double-blind patient-controlled intravenous or epidural analgesia with sufentanil. Within 15 minutes after the initial intravenous bolus injection of 15 micrograms sufentanil respiratory depression occurred in 4 patients. This was alerted by the Oscar-CO2-Monitor and -Pulsoximeter. Oxygen saturation time patterns of pulsoximetry and blood gas analysis correlated significantly (p < 0.001), although the mean values of the methods differed (NS). In contrast, carbon-dioxide pressure time patterns of capnometry and blood gas analysis correlated less significantly (p < 0.01) although the mean values of the methods correlated significantly (p < 0.01). Concomittant monitoring via pulsoximeter and capnometer is therefore superior to regulary assessments of respiratory rate and blood gas analysis and potentially useful for the clinical routine.

Adult↗
PubMed1995

Assessment of pain threshold and pain tolerance in women in labour and in the early post-partum period by pressure algometry.

The changes in the pressure pain threshold (PPThr) and pressure pain tolerance (PPTol) in 41 parturients have been studied during the active phase of labour and in the early post-partum period. The sensitivity to pressure stimuli was examined with an electronic pressure algometer placed on the sternum during the interval between painful contractions, after extradural analgesia and 24 h after childbirth. Prior to extradural analgesia, mean (+/- SD), PPThr and PPTol were 4.9 +/- 1.6 kg 0.25 cm-2 and 6.9 +/- 1.8 kg 0.25 cm-2, respectively. Similar values were recorded 1 h after induction of the extradural block when the pain of labour was abolished. At 24 h post-delivery, a significant decrease in both PPThr and PPTol was noted (P < 0.001). The lack of influence of extradural analgesia on pressure algometry values, and the elevated sensitivity to pain in the early post-partum period, may be related to the influence of pregnancy and labour on the appreciation of pain.

Adult↗
PubMed1995

[Value of acupuncture in treatment of migraine].

Approximately 12% of the population suffers from migraine. This sudden, usually unbearable headache can last for up to 72 hours and can be accompanied by vegetative symptoms. Prophylactic treatment is recommended if more than three attacks of headache occur monthly. For prophylactic therapy, beta-blockers or the calcium antagonist flunarizine are mostly used. Serotonin blockers, which have undesirable side-effects, and dihydroergotamine, which can only be used for a short time as well as non-steroidal antirheumatics and antidepressants and relaxation exercises are used more rarely. The literature reports on the successful treatment of migraine with acupuncture. Although none of the studies made to date fulfil the necessary quality criteria, there is no doubt about the efficacy of acupuncture in the treatment of migraine. Acupuncture therapy only makes sense if it reduces the patient's discomfort and the taking of drugs.

Acupuncture Therapy↗
PubMed1994

Epidural versus subcutaneous administration of alfentanil for the management of postoperative pain.

This study was designed to compare the efficacy and serum concentrations of alfentanil given subcutaneously (SQ) or epidurally (EPID) for treatment of postoperative pain. Following abdominal surgery, patients (n = 12) were randomly assigned to receive double-blind SQ or EPID alfentanil over 24 h via the allocated route (1 mg along with 0.2 mg/h and 0.2-mg boluses on demand) and saline via the other route of administration using a patient-controlled analgesic (PCA) delivery system. Significantly less EPID alfentanil produced better quality analgesia and fewer side effects than SQ alfentanil. The fact that EPID analgesia was maintained with serum alfentanil concentrations less than those producing systemic analgesia confirms the spinal site of the EPID alfentanil action.

Abdomen↗
PubMed1994

[Clinical use of alfentanil].

The fentanyl derivative alfentanil is a potent analgesic characterized by a quick onset time, short duration of action, low toxicity and short elimination time. Alfentanil is mainly used intraoperatively. In minor operations, its intravenous application is sufficient for anaesthesia. In major operations, the need for other anaesthetics can be reduced by the application of alfentanil. The best form of application is the computer-controlled infusion of alfentanil. The advantage of alfentanil over other opioids is the short recovery time of the patient. Alfentanil can also be used postoperatively for pain relief. Used intravenously after abdominal operations, it is approximately ten times more effective than morphine. Applied peridurally its analgesic effect corresponds approximately to that of morphine. Based on the lower amount of alfentanil needed, the patient-controlled application of alfentanil is superior to the use of constant infusion rates. In combination with midazolam, alfentanil can also be used for analgosedation of intensive care patients. Alfentanil is less useful for the treatment of cancer pain since it leads to greater development of tolerance than other opioids.

Adult↗
PubMed1993

A randomized double-blind comparison of epidural sufentanil versus intravenous sufentanil or epidural fentanyl analgesia after major abdominal surgery.

This randomized double-blind study compared epidural sufentanil (SEPI) with intravenous sufentanil (SIV) or epidural fentanyl (FEPI) analgesia in 45 patients after major abdominal operations. On first complaint of severe postoperative pain, SIV patients were given a 15-micrograms bolus and then a 5 micrograms/h infusion of sufentanil intravenously. SEPI patients were given the same bolus and infusion, but epidurally. FEPI patients had a 60-micrograms bolus and 20 micrograms/h infusion of fentanyl epidurally. All patients also received a bolus injection and then an infusion of coded saline via the alternate route. Analgesic requirements were tailored continuously to individual needs by patient-controlled supplementary boluses of 3.1 micrograms of sufentanil or 12.5 micrograms of fentanyl, or by 50% reduction in opiate infusion rate at predetermined intervals. Pain scores, circulatory variables, and respiratory rate did not differ between groups. Mean opiate dose requirements (+/- SD) to maintain analgesia for 24 h were 202 +/- 43 micrograms (SIV), 149 +/- 45 micrograms (SEPI), and 627 +/- 226 micrograms (FEPI). The relative analgesic potencies (AP) calculated from the equianalgesic dose requirement ratios were 1.4 for AP-sufentanil IV/EPI and 4.2 for AP-epidural F/S. SIV patients required more supplementary boluses than SEPI patients, were more sedated during the entire treatment, and had higher PaCO2 and higher serum sufentanil concentrations within the first 3 h of treatment. In addition, severe respiratory depression occurred in four SIV patients soon after the start of treatment, despite serum sufentanil concentrations of less than 0.3 ng/mL.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1993

Non-opioid peptides for analgesia.

Amongst the spinal peptide candidates believed to be involved in the mediation of analgesia, only somatostatin fulfills the criterium of a real analgesia substance. Spinal somatostatin specifically blocks the transmission of painful stimuli. Spinal calcitonin may lower the opioid dose requirement in patients with bone metastases but it fails to relieve acute pain. The usefulness of ACTH and CRF for treatment of pain remains to be established. The role of CCK-8, vasopressin and neurotensin is unclear. The contradictory findings on antinociception using simple rodent withdrawal reflex tests (e.g. the tail flick test), or more complex behavioral tests in which supraspinal sensory processing is involved, (e.g. the hot plate test), indicate that these tests are inappropriate when neuropeptides are employed. Furthermore, due to their inability to predict analgesia in humans, they do not fulfill the guidelines proposed by the IASP that animal test procedures have to be for the benefit of humans.

Analgesia↗
PubMedDate not supplied

Comparison of morphine with and without fentanyl for epidural analgesia after major abdominal surgery.

BACKGROUND AND OBJECTIVES: The study compared bolus injection of fentanyl versus morphine to supplement epidural infusion of morphine for pain relief after major abdominal surgery. METHODS: Postoperative epidural analgesia was activated by patient request for pain relief. Thirty patients were given a loading dose (random assignment, double-blind administration) of 2 mg of morphine (group M, n = 15) or 60 micrograms of fentanyl (group F/M, n = 15), along with an epidural infusion of 0.2 mg/h of morphine. Additional boluses of 0.5 mg of morphine (group M) or 25 micrograms of fentanyl (group F/M) were given according to individual need. If patients were painfree for 3 hours, the infusion rate for morphine was reduced by 50%. RESULTS: Both treatments provided similar degrees of analgesia, although onset time was shorter for the F/M group (P < .05). To obtain 24 hours of analgesia, group M needed 18.0 mg of morphine, while group F/M needed 4.7 mg of morphine and 1.48 mg of fentanyl. For group M, mean serum concentrations of morphine decreased from 18 ng/mL at 1 hour from the start of treatment to 5 ng/mL at 24 hours. For group F/M, serum morphine stayed at approximately 4 ng/mL, but serum fentanyl increased from 0.28 ng/mL at 5 minutes to about 0.8 ng/mL at 16 hours. CONCLUSIONS: When fentanyl is added continuously to epidural morphine, the resulting higher total serum levels of opioids during prolonged treatment may increase the risk of respiratory depression. Combining the two opioids for the loading dose, however, may be valuable to shorten the onset time of analgesia.

Abdomen↗