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Biomedical subjects

S Piepenbrock

Publications and source records attributed to S Piepenbrock.

At least 109 records · Page 6Linked to original sources
PubMed1993

Plasma volume estimation using indocyanine green. A single intravenous injection method.

The validity and reliability of plasma volume estimation using indocyanine green were investigated in five in vitro experiments and in three in vivo series. The in vitro measurements reflected real volumes with an error of about 1%. Comparative measurements in the same patients using indocyanine green or Cr51 labelled red cells differed by 1.7% (r = 0.97). The mean (SD) plasma volume difference between two successive plasma volume measurements using indocyanine green was 38 (43) ml (r = 0.99). Plasma volume measured before and about 7 min after a hyperosmolar saline bolus (100 ml, 1 molar) was increased by 223 (102) ml and 286 (49) ml when determined by indocyanine green and plasma protein changes respectively. Nevertheless, the necessity for central venous injection and arterial sampling restricts the possible application of the method to intra-operative or emergency care use.

Blood Volume Determination↗
PubMed1993

[Propofol, isoflurane and neuroleptanesthesia. Ophthalmic surgery in geriatric patients].

Ophthalmic surgeons require anaesthesia to ensure that the patient is completely relaxed for microsurgical operations and that the intraocular pressure is reduced. These conditions must be maintained throughout the operation. In addition to these requirements, the anaesthetist mostly deals with elderly patients with multiple diseases. Although earlier studies have shown which general or local anaesthesia is preferred for which patients and operations, studies on which general anaesthesia technique is ideal to fulfil these requirements are still lacking. The aim of this study was to show which technique causes the least stress for a geriatric patient undergoing an ophthalmic operation, propofol/fentanyl anaesthesia, isoflurane anaesthesia or neuroleptanaesthesia. PATIENTS AND METHODS. Sixty patients aged 60 years and above were included in this study. After being randomly allocated to either propofol/fentanyl (continuous propofol infusion), isoflurane or neuroleptanaesthesia, they underwent ophthalmic surgery. Intraoperative complications (cardiocirculatory changes) and surgical conditions were recorded. After the operation, patient vigilance and post-operative pain reactions (nominal pain score) were assessed over 8 h by means of simple reaction tests and the Juhl index. Within the first 2 h after surgery, cardiocirculatory changes were also documented and arterial blood gases measured. RESULTS. The treatment groups did not differ with respect to general biometric data, preoperative risk or operations carried out. Intraoperative cardiocirculatory changes and the resulting therapy (positive inotropic drugs, volume replacement fluids) were similar in all groups. The surgical conditions were equally good in all groups. Apart from a lower rate pressure product in the first 60 min after propofol/fentanyl anaesthesia, there were no postoperative differences in cardiocirculatory parameters or blood gases. After isoflurane anaesthesia the time until the patients were able to give their names and perform the finger-nose test properly was longer than that after neurolept-anaesthesia or propofol anaesthesia. After propofol anaesthesia the patients could perform simple tests earlier and were more alert over the whole monitoring period than after isoflurane or neuroleptanaesthesia. On the other hand, the patients in the neuroleptanaesthesia group had fewer pain complaints than those in the two groups compared. DISCUSSION. None of the anaesthesia techniques used in this study showed an intraoperative advantage. This is not surprising since all anaesthetics, with the exception of ketamine, reduce intraocular pressure. The prerequisite, however, is careful monitoring of anaesthesia in elderly patients in order to avoid cardiocirculatory changes, mild hyperventilation and coughing and pressing at the end of the operation. Until this point in time no change in the depth of anaesthesia is allowed. Therefore, it seems on the whole that there are benefits from propofol-fentanyl anaesthesia because of the fact that in comparison with the rather techniques, elderly patients become alert again faster. However, sufficient postoperative pain therapy is necessary to free the patients of pain to the same degree as with neuroleptanaesthesia. In most cases peripherally acting analgesic substances with no interference with vigilance are sufficient.

Aged↗
PubMed1991

Short term volume effects of a hypertonic saline bolus during neurosurgery.

Intracranial hypertension which does not respond to customary hyperosmotic agents may successfully be treated with hypertonic saline. The absence of diuresis and the maintainance of intravascular volume are supposed to be the main advantages of hypertonic sodium chloride. Volume overload and toxic hyperosmolality from frequent application of such solutions are possible disadvantages. The presented experiments checked the time course of intravascular volume shifts after a 100 ml 1-molar saline bolus in 14 patients during neurosurgery using plasma protein concentration changes. An initial intravascular volume expansion of about 270 ml remained quite unchanged for the first 8 minutes, followed by a nearly linear decrease. Extrapolation of the curves demonstrated that the preinfusion state would have been reached after about 20 minutes. Osmolality remained increased by about 4 mosmol/kg 15 min after the bolus. Thus it appears that repetitive infusion of these amounts of hypertonic saline will cause no serious volume overload if 30 minutes intervals are kept, but osmolality should be checked before each bolus.

Adult↗
PubMed1989

[Percutaneous transtracheal ventilation using Nu-Trake cricothyreotomy instruments and tracheoscopic follow-up examination].

Practicability and efficiency of the cricothyreotomy set Nu-Trake was investigated in corpses (n = 10) in the institute of Pathology and clinically in laryngectomy patients (n = 5) including endoscopical controls. The practicability proved to be good, the time needed to perform the coniotomy did not last longer than 2 minutes. But complications in the investigation on the corpses could not be avoided. These were missing the lumen of the trachea, perforation of the pars membranacea tracheae and fracture of the cricoid. The clinical investigation demonstrated a sufficient oxygenation and ventilation in all patients during the whole investigation period (30 min). This can be explained by the diameter of 7.2 mm of the used tube. Endoscopic controls showed a sufficient distance of the tip of the tubes from the pars membranacea tracheae and almost no bleeding within the trachea. Similar as with other coniotomy-technics the cricothyreotomy with the Nu-Trake set bears the risk of typical complications which have to be overcome by training of this important measure of emergency.

Aged↗
PubMed1989

[Local anesthetic level and cardiovascular changes following local anesthesia in cataract operations with 3% mepivacaine].

Are there toxic plasma levels of mepivacaine after local anesthesia for ophthalmic surgery with 3% mepivacaine? What hemodynamic changes occur during injection of the local anesthetics? Fifteen patients undergoing cataract surgery were given 10 ml of mepivacaine (3%) as a local anesthetic regardless of body weight. After inserting an arterial line, blood samples were taken before the beginning of the injection of mepivacaine and after 3, 5, 10, 15, 30, and 60 min. Concentrations of the drug were measured by gas chromatography. During the first 15 min arterial blood pressure and ECG were registered continuously on a multichannel recorder. The maximum mepivacaine plasma levels were estimated after 15 min with a range from 0.28 to 6.95 micrograms/ml (means +/- SD: 4.5 +/- 1.47 micrograms/ml). The blood pressure was elevated over the preoperative value, at the beginning of the evaluation period, but there was no change in the blood-pressure level over the whole period. In 4 patients without known cardiac arrhythmias, ventricular or supraventricular extrasystoles occurred. The mepivacaine plasma levels complied with resorption kinetics, which is an indication that there were few intravascular injections and that the injection technique war correct. On the other hand, in some patients the mepivacaine plasma levels exceeded the toxic level. Even in ophthalmic surgery, local anesthetics should be given in relation to the body weight of the patients. The high blood-pressure levels indicated non-optimal preoperative treatment of the hypertonic patients, which was followed by an intraoperative exacerbation of the blood pressure.

Aged↗
PubMed1988

[Nalbuphine in comparison with piritramid and placebo in postoperative pain therapy following intubation anesthesia with halothane. Side effects and effectiveness].

UNLABELLED: The aim of the study was a comparison of the side-effects and efficacy of nalbuphine, piritramide, and placebo in patients during recovery from halothane anesthesia. METHODS: Neurosurgical (vertebral surgery) and otolaryngological patients (surgery of face and neck) were operated under halothane anesthesia. Postoperatively 20 patients received 20 mg nalbuphine, 21 patients 15 mg piritramide, and 19 patients 0.9% NaCl for pain therapy in a randomized and double-blind manner. Respiratory function was monitored by blood gas analysis, hemodynamic function by noninvasive measurements. The analgetic and sedative effects were estimated by the patients (visual analog scale) and the investigator (4-point scale). If the treatment was ineffective, the study was interrupted and a known analgesic was prescribed. RESULTS: The noninvasively measured hemodynamic parameters were unchanged. On the other hand, in the nalbuphine group mean arterial pCO2 increased significantly (max. 55.4 mmHg after 20 min), over the piritramide group (max. 51.2 mmHg before treatment) and the placebo group (max. 55.1 mmHg before treatment). Drowsiness, in 8 patients in each of the treatment groups and 3 patients in the placebo group, was the most frequent side-effect. After nalbuphine the pain threshold was significantly higher than after treatment with piritramide and placebo. The study was interrupted because of inefficacy in no patients from the nalbuphine group, 2 patients from the piritramide group, and 6 patients from the placebo group. There were no differences in the sedative effects. CONCLUSIONS: Nalbuphine seems to have better analgesic effects then piritramide. Both cause no hemodynamic alterations.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Endotracheal↗
PubMed1988

[Critical comments on reports of fatalities in hereditary fructose intolerance in adulthood from the viewpoint of neuroanesthesia].

In view of repeated communications in recent years reporting on lethal infusions of fructose or sorbitol in adults with hereditary fructose intolerance, the known statements on the incidence of 1:20,000 are critically analysed. The validity is relativated. The special indication for sorbitol as an osmotherapeutic preparation for lowering intracranial pressure is pointed out. A modified intravenous fructose tolerance test is suggested.

Adult↗
PubMed1988

[Perioperative anxiety and postoperative pain suppression in intraocular operations using general anesthesia and local anesthesia].

UNLABELLED: Intraocular surgery is performed under local or general anesthesia. The indications for these procedures are often dependent on local circumstances. On the one hand, the optimal conditions for operations under general anesthesia, on the other, the negligible stress of local anesthesia, especially for the elderly, are emphasized. To clarify this question, perioperative anxiety behavior and postoperative pain were investigated in geriatric patients undergoing ophthalmic surgery. METHODS: Spielberger's state trait anxiety inventory (STAI) was performed in 31 patients operated on in general (age 71.0 +/- 6.6 SEM) and 31 operated on in local anesthesia (age 71.6 +/- 6.0 SEM) the day before and 4 h after operation. 10 patients in each group were also tested immediately before surgery in the operating room. Postoperative pain was estimated by the patient and postoperative sedation by the investigator using a 4-point scale for each over 8 h. RESULTS: The state (STAI 1) and trait (STAI 2) anxiety scores did not change in these geriatric patients. There were no significant differences between the groups. Postoperative pain was significantly (p less than 0.05) higher after 15 and 60 min after general anesthesia. There was no difference in the frequency of analgetic therapy in both groups, but most opioids were given in the first 90 min after general anesthesia. The patients were more frequently sedated (p less than 0.05) in the first 90 min after general anesthesia then after local anesthesia. DISCUSSION: The scores of state and trait anxiety behavior are comparable to a normal geriatric population, even if normal data cannot always be applied to clinical situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Acute lowering of blood pressure by infusion of hyperosmolal sorbitol solution in brain operations. Dangerous adverse effect or favorable side effect?].

Osmotherapy with sorbitol 40% during intracranial surgery using neurolept analgesia usually produced acute decreases in arterial blood pressure. Haemodynamical measurements during intraoperative infusions of sorbitol in 97 patients showed a rapid decrease of arterial mean pressure from 91 to 72 mm Hg. In 22 of these patients cardiac output measurements were performed. Increases of cardiac index from 2.5 to 4.3 l/min x m2 could be found. The hypotensive side effect can be used for treatment of reactive arterial hypertension in neurosurgical patients during surgery where this therapy is advantageous per se because of its cerebral dehydrating effects. The decrease of blood pressure is obviously caused by peripheral vasodilatation. Cardiac disturbances were not observed. Other side effects, especially the danger of hereditary fructose intolerance are discussed.

Blood Pressure↗
PubMed1987

[Anesthesiological care of female patients with cerebrovascular aneurysms in pregnancy].

This is a report on a patient who suffered subarachnoid haemorrhage from an aneurysm of the a. cerebri media during the 28th week of pregnancy. The aneurysm was clipped under neuroleptanalgesia. Besides monitoring of heart rate, blood pressure and central venous pressure as well as the treatment parameters including end-expiratory CO2, the foetal heart rate was deduced by Doppler sonography. She was hyperventilated intraoperatively with a paCO2 of 3.8-4.1 kPa. During the actual aneurysm surgery, artificial hypotension by 20 mmHg to b.p. values around 100/160 mmHg was initiated by means of nitroglycerin. It is evident from the literature compiled on this occasion that it is mandatory to monitor foetal heart rate during controlled hypotension in pregnancy. Sodium nitroprusside should not be used to initiate artificial hypotension during pregnancy, since it may result in toxic cyanide levels in the foetus. As usual in neurosurgery, hyperventilation can be performed also during pregnancy, since placental blood flow decreases only if the CO2 concentration drops to a very low level.

Adult↗
PubMed1986

[Nalbuphine and tramadol for the control of postoperative pain in children].

The postoperative treatment of pain in children is often inadequate: Periphal acting analgetics are not sufficient, opioids are believed to be dangerous because of their respiratory depression. Nalbuphine and tramadol are two narcotics with only a few side effects. The aim of this trial was to investigate the efficacy and safety of these drugs in postoperative pain therapy in children aged 1-9 years. 30 children in each group received in a double-blind and randomized manner either 0.15-0.2 mg/kg nalbuphine or 0.75-1.0 mg/kg tramadol im. Pain intensity and sleep-awake behaviour were documented by a visual analogue scale for 24 h. After 1 h 70% of the patients in both groups had no pain and were sleeping. There was no change in heart rate and systolic blood pressure. Only the diastolic blood pressure decreased as did the respiratory rate, while the tcpCO2 estimated in some patients remained constant. Narcotic reinjections were necessary three times in the nalbuphine group and four times in the tramadol group. Typical opioid side effects were found to be equal in both groups.

Blood Pressure↗
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

[Anesthesiologic aspects of chemonucleolysis in local anesthesia].

After treatment of herniation of a lumbar disc by injection of the enzyme chymopapain, i. e. after chemonucleolysis, anaphylactic reactions can occur in about one per cent of the cases. In order to recognise the pattern of signs associated with such reactions, well in advance, while avoiding the additional risk of general anaesthesia, some authors propagate local anaesthesia. We report on our perioperative procedure in 102 cases of chemonucleolysis under local anaesthesia. Prick's tests were carried out before surgery to exclude sensitization to the substances to be injected. In two cases only due to a positive prick test to chymopapain chemonucleolysis had to be effected with collagenase; as a matter of fact, collagenase is not known to have caused any anaphylactic reactions, but it may be responsible for local side effects, such as destruction of adjacent tissues. The patients were kept under observation by an anaesthetist during and after surgery. No anaphylactic reaction was seen. Chemonucleolysis appears to be a suitable treatment method provided it is carried out under local anaesthesia with the same precautions as applied under regional anaesthesia by the anaesthetist.

Adult↗