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Biomedical subjects

T Pasch

Publications and source records attributed to T Pasch.

At least 109 records · Page 6Linked to original sources
PubMed1989

Biochemical and hormonal parameters in patients with multiple trauma.

We measured amount, course and duration of different parameters in order to assess metabolic-endocrine changes in patients with multiple trauma and the final outcome. Injures were initially quantified according to the Injury Severity Score. Serum levels of lactate, creatinine, bilirubin, somatomedin and thyroid hormons were measured in 51 patients (39 survivors, 12 deceased patients) for six days following the injury. In addition, neopterin levels were measured in 26 patients (19 survivors, 7 deceased patients). The patients were devided into two groups (survivors vs non-survivors). Global Index Scores and Septic Severity Scores were significantly different at the 1% and 5% level (p less than 0.05 to p less than 0.01). The same statistical differences were shown for lactate, somatomedin, neopterin and thyroid hormones.

Biomarkers↗
PubMed1987

Can the outcome after trauma or sepsis be predicted from biochemical or hormonal parameters?

The severity of shock of 36 surgical ICU patients was classified using the Injury Severity Score (N = 20) and the Sepsis Score (N = 16). A great number of laboratory parameters were repeatedly determined on 5 days following the trauma or the onset of septic symptoms. Blood lactate, C-peptide, BUN, osmolality, and thyroid hormones were most closely related to the severity of the disease. This correlation was, however, less pronounced in the trauma than in the septic patients. Lactate and thyroid hormones showed a typical course in the non-survivors and may therefore be valuable as prognostic indices.

Adolescent↗
PubMed1987

[Effect of fentanyl and enflurane on sensory evoked potentials in the human in basic flunitrazepam/N2O anesthesia].

The use of evoked potential recording is commonly employed for monitoring peripheral and central sensory functions during neurosurgical procedures. However, the neuronal structures studied must not be changed by the anesthetic agents used. In this connection, the influence of two anesthetics, fentanyl and enflurane, on evoked potentials was investigated under basic anesthesia. A total of 60 patients undergoing lumbar disc removal were included in the study. Somatosensory (SEP), auditory (AEP), and visual (VEP) evoked potentials were each recorded in 20 patients the day before operation. Basic anesthesia was induced with flunitrazepam, nitrous oxide, and pancuronium bromide. Following induction, recordings of evoked potentials were again made. One half of each group of 20 patients received increasing doses of fentanyl (1.8, 3.6, and 7.2 micrograms/kg in the somatosensory and auditory groups; 4.0 and 8.0 micrograms/kg in the visual group). The other half was given increasing inspiratory concentrations of enflurane (0.5, 1.0, and 1.5 vol.%). At each level of anesthesia, SEPs, AEPs or VEPs were recorded. As compared with preoperative recordings, post-stimulus latencies were virtually unaffected by the basic anesthesia. Fentanyl caused little increase in the latencies of middle-latency-SEPs and of peak P2 of the VEPs. With enflurane, however, the latencies of the SEPs were dose-dependently prolonged, in particular those of the later components (P25 to N55). The same was true for the peak P2 in the VEPs. AEPs were not changed at all. From the results it can be concluded that enflurane, but not fentanyl, impairs impulse conduction in central synaptic pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1986

[Rebound hypertension after controlled hypotension and its prevention by captopril].

In 27 patients undergoing ear, nose and throat surgery, the problem of post-hypotensive hypertension (rebound hypertension) following vasodilator-induced controlled hypotension was studied, together with prevention by the ACE inhibitor captopril. Hypotension was induced by sodium nitroprusside (SNP) in seven patients (group 1) and by nitroglycerin (NTG) in ten patients (group 3). Ten patients (group 2) received 25 mg captopril given orally, together with the preanaesthetic medication, as well as SNP. The degree and duration of the decrease in blood pressure did not differ significantly between groups. After discontinuation of the respective vasodilators, blood pressure had increased to above prehypotensive levels in both group 1 (SNP) and group 3 (NTG) 30 min afterward and, to a more marked extent, 60 min afterward. In these groups plasma renin activity (PRA) increased continuously during the hypotensive period up to 11.4 +/- 2.4 and 19.5 +/- 4.5 ng/ml/h, respectively, and had not yet reached its prehypotensive value 60 min after discontinuation. In group 2 (captopril/SNP) there was no overshoot hypertension on discontinuation of SNP, and the average infusion rate of SNP was reduced. PRA was markedly higher than in groups 1 and 3 (peak level 27.9 +/- 6.5 ng/ml/h) due to inhibition of the feedback mechanism in the renin-angiotensin system. From the results it may be concluded that both SNP and NTG can cause rebound hypertension, the extent of which depends on the level of hypotension previously achieved and the infusion rate of the vasodilator. Pretreatment with captopril prevents the rebound and reduces the dosage of vasodilator required and, therefore, may be considered an alternative to the well-documented beta-adrenergic blockers.

Adult↗
PubMed1986

[Patient monitoring during anesthesia].

Three functional levels are monitored during anaesthesia: vital functions such as cardiovascular and respiratory systems; metabolic functions; and organs such as brain and muscle. These three levels interact with each other and with the anaesthesia system. Basic monitoring systems include the ECG, noninvasive blood pressure measurement, inspired O2 concentration, tidal volume, airway pressure, and alarm systems for stenosis and disconnection. Other monitors are added to this list, including pulse oximetry, capnography, temperature, and neuromuscular transmission. The type of surgery and anaesthetic risk will determine the extent of the monitoring used during surgery. New and expensive noninvasive monitoring techniques such as transesophageal Doppler echocardiography and somatosensory evoked potentials will increasingly be added. The high costs and the rising number of monitoring systems necessitate a better definition of what is essential and what is optional for each individual case.

Anesthesia↗
PubMed1986

Cerebral complications following induced hypotension.

Over an 8-year period (1977-1984), 1,802 otorhinolaryngological procedures were performed under controlled hypotension. Four patients showed symptoms of cerebral damage post-operatively. One patient had pre-operative unrecognized stenosis of the internal carotid artery, another a hypoplastic vertebral artery. In this female patient, the head had been strongly rotated to the side to expose the surgical field, and the internal jugular vein removed. She died of general ischaemic brain damage on the seventh post-operative day. In the remaining two patients, symptoms of cerebral ischaemia did not occur until the third and eleventh day, respectively, so that the causative role of hypotensive anaesthesia is uncertain. The cases described represent a cerebral morbidity of 4:1,802 (0.22%) and a mortality of 1:1,802 (0.06%). It is concluded that controlled hypotension is a safe technique if the indication is stringently applied, and any risk-bearing factors are carefully excluded.

Adult↗
PubMed1986

[Effect of isoflurane on respiratory mechanics].

The effects of the inhalational anaesthetic, isoflurane, on two major parameters of respiratory mechanics--resistance and compliance--were studied in a total of 30 patients. With increasing inspiratory concentrations of isoflurane, resistance was measured in 5 spontaneously breathing patients using the oscillation method. In 16 mechanically ventilated patients resistance and compliance were calculated from airway pressure, gas flow, and tidal volume. In 9 patients with asthma or COPD the course of resistance and compliance was recorded intraoperatively. An increase in resistance of up to 117% of the initial volume occurred during spontaneous respiration, and was caused by a decrease in tidal volume. During mechanical ventilation with constant tidal volume, no definite changes in resistance or compliance were seen with increasing isoflurane concentrations. In the patients with elevated airway resistance there were only minor, statistically non-significant changes in resistance and compliance. The results show that the effects of isoflurane on respiratory mechanics do not differ from those of halothane or enflurane. Therefore, isoflurane may be considered appropriate for use in patients with impaired airway resistance.

Adult↗
PubMed1986

[Changes in water balance and kidney function caused by cardiopulmonary bypass].

The authors studied in 42 patients, 35 normotensives and 7 hypertensives, undergoing open-heart surgery, the perioperative behaviour of renal function and fluid balance. Before cardio-pulmonary bypass (CPB), there was a prerenal impairment of renal function caused by reduced fluid intake. During CPB a marked osmolal diuresis without tubular failure occurred. The amount of positive fluid balance was proportional to the duration of CPB. In those hypertensive patients in whom CPB perfusion pressure was below 50 mmHg, the creatinine clearance decreased by 67% during this period. The results indicate that the extent of CPB-induced renal dysfunction is tolerable and does not result in renal failure provided an adequate perfusion pressure is maintained. However, the consequences of marked water retention for undisturbed vital organ function must be taken into consideration.

Acute Kidney Injury↗
PubMed1984

[Noninvasive determination by Doppler flow velocity recording of changes in peripheral resistance during epidural anesthesia].

Using bidirectional CW Doppler flowmetry, transcutaneous recordings of flow velocity pulses were performed on the femoral artery of 11 patients before and during peridural anaesthesia. Compared to those obtained before peridural injection of bupivacaine the pulse contours exhibited characteristic changes 10 min after the injection. The backward flow wave during diastole decreased or disappeared. There was a marked increase in the steady flow at the expense of the pulsatile flow peaks. 20 min after injection these changes were slightly more pronounced. These phenomena can theoretically be explained by the alteration in pulse wave transmission in the arterial system caused by the diminished peripheral resistance. From the results it can be concluded that ultrasonic Doppler flowmetry is a reliable method, suitable for recording the influence of regional anaesthesia on peripheral haemodynamics.

Adolescent↗
PubMed1983

Methaemoglobin levels during nitroglycerin infusion for the intraoperative induction of controlled hypotension.

The methaemoglobin formation resulting from the intravenous infusion of nitroglycerin, was investigated, intraoperatively, in 46 patients in whom the substance was used to achieve controlled hypotension. The mean infusion rate was 3.50 +/- 0.38 micrograms/kg/min, and the mean duration of the infusion 87 +/- 7.0 min (mean +/- SEM). The concentrations of methaemoglobin were measured prior to, during, and also 60 min after, the infusion of nitroglycerin, using an IL CO Oximeter 282. The control level of the methaemoglobin prior to the start of infusion was 0.6 +/- 0.1%. Nitroglycerin infusion resulted in a slight increase in the level of methaemoglobin of about 1% maximum, which showed no correlation with the total dose of nitroglycerin or the rate of infusion. The mean maximum methaemoglobin level was 0.9 +/- 0.2%. The results suggest that, at average infusion rates of up to 10 micrograms/kg/min, nitroglycerin does not give rise to any clinically significant methaemoblobinaemia.

Adolescent↗
PubMed1982

Cyanide toxicity of sodium nitroprusside in therapeutic use with and without sodium thiosulphate.

Sodium nitroprusside (SNP) as a mono-infusion was administered to 51 patients for periods of a few hours. A further group of 19 patients received SNP for periods of several days as a combination solution of SNP mixed with sodium thiosulphate. The concentrations of cyanide and of thiocyanate in the blood of all patients were measured. In seven of the patients the level of thiosulphate was also measured. Infusion of SNP on its own at levels exceeding 2 microgram/kg/min led to the rising of cyanide levels in the blood being proportional to dosage. Infusion of SNP mixed with thiosulphate showed no such accumulation of cyanide in any patient, irrespective of dosage level and duration. The efficacy at lowering blood pressure was fully maintained in the mixed infusion. The elimination half-life for thiosulphate was 16.5 min. Pharmacokinetic calculation of the rise in cyanide level showed that mono-infusions of 5-10 micrograms SNP/kg/min could within 5-10 h cause a life-threatening cyanide level in the blood. By contrast, mixed infusion of SNP together with thiosulphate, for which light-opaque syringes and tubing must be used, is a procedure free of danger and should become the technique of choice when therapeutically administering SNP in order to lower blood pressure.

Adolescent↗
PubMed1982

[Deliberate hypotension during rhinosurgery using labetalol, a combined alpha- and beta-adrenoceptor antagonist (author's transl)].

In 70 patients undergoing rhinosurgical operations, the applicability of labetalol, a drug that blocks both alpha- and beta-adrenoceptors, to intraoperative deliberate hypotension was studied. Anaesthesia was induced with diazepam/fentanyl or thiopental/fentanyl and maintained with N2O/O2 (2:1) and enflurane. Additionally, in combination with 0.3-0.5 mg/kg labetalol intravenously, enflurane was used for lowering arterial blood pressure. The average concentrations of enflurane needed to decrease the systolic pressure to values between 75 and 90 mm Hg in normotensive patients, ranged from 0.6 to 1.2 vol. % (mean 0.92 +/- 0.28). The heart rate was virtually stable throughout the operating procedure. After discontinuation of enflurane and administration of 0.01 mg/kg atropine, the blood pressure promptly returned to its preanaesthetic level and then remained constant during the postoperative period. From the results of this study it may be concluded that, combined with small amounts of inhalational anaesthetics, e.g. enflurane, labetalol (0.5 mg/kg) can safely be used for achieving hypotensive blood pressure levels during operations lasting 90 minutes maximum. Impending major blood losses and contraindications for the use of beta-blockers have to be excluded.

Adult↗
PubMed1981

[The use of flunitrazepam in ICU patients (author's transl)].

Flunitrazepam exhibits principally the same effects as other benzodiazepines, i.e. sedation, sleep induction, amnesia and muscle relaxation. These effects are maintained for several hours and are additive to those of other drugs, e.g. narcotic analgesics. When flunitrazepam is used in ICU patients its long duration of action and depressant influence on the respiration have to be taken into account. Therefore it is preferred in cases with severe cerebral trauma, prolonged sepsis, or tetanus requiring long-term respiratory treatment. The mean single dose is 1.0 mg and the interval between consecutive doses is, on average, 2 to 3 hours. After prolonged use of flunitrazepam, at least 24 to 48 hours are necessary for sedation and muscle relaxation to disappear to such an extent that transition from mechanical to spontaneous ventilation is possible. Severe side-effects, e.g. cardiac arrhythmias, metabolic disturbances, impairment of renal function, changes in electrolyte or acid-base balance, have not been observed. Peripheral vasodilation is common and may lead to a decrease in arterial blood pressure.

Animals↗
PubMed1979

[Influence of narcotic analgesics, droperidol, diazepam, and flunitrazepam on the smooth muscles of small arteries (author's transl)].

In isolated segments of the rat tail artery, the influence of narcotic analgesics, their antagonists, droperidol, diazepam, and flunitrazepam on the vascular smooth muscle was investigated. The wall of this vessel consists of about 75 per cent smooth muscle fibres. For all agents studied, pressure-diameter relations were determined before and after a virtually maximum constriction which was induced with noradrenaline. The results were compared with those obtained under control conditions, i.e. prior to the addition of the drugs to the bath solution. Tested in pure Tyrode's solution, none of the agents produced a noticeable constriction or relaxation. Among the analgesics and their antagonists, morphine was the most potent in inhibiting the noradrenaline-induced constriction of the vessel (mean increase in diameter 15%). Pentazocine and levallorphan were less effective (mean increase 8%), and the administration of pethidine and naloxone was followed by even less relaxation, resulting in mean diameter increases of 4%. Piritramide and fentanyl did not show any effect. Depending on the pressure level, droperidol caused the diameter to increase 2 to 10%. Flunitrazepam brought about a marked relaxation (mean increase in diameter 15%), diazepam, however, did not influence the vessel segments. The results obtained show that the haemodynamic effects of the drugs used in this study, in particular those on the peripheral resistance, may, at least partially, be due to their direct influences on the vascular smooth muscle. The real pharmacologic mechanisms by which these effects are initiated, in most cases still remain to be investigated.

Analgesics, Opioid↗
PubMed1979

[Effects of various anaesthetics and relaxants on vascular smooth muscle (author's transl)].

The effects of various injectable anaesthetics and relaxants on the pressure-diameter relations of isolated segments of the rat tail artery were investigated in vitro. The wall of this vessel contains about 75% smooth muscle fibres. Measurements were made before and after the induction of a virtually maximum constriction of the vascular segments which was produced by 1 mg/ml noradrenaline. When added to pure Tyrode's solution all the agents used did not markedly influence the pressure-diameter curves. However, the noradrenaline-induced constriction of the vessels was inhibited to varying degrees. This effect was most evident after thiopentone which caused the diameter to increase by 50%. After pentobarbitone, the increase in diameter was found to be less pronounced (15%). Administration of methohexitone was followed by lesser relaxation of the arterial smooth muscle resulting in a maximum increase in diameter of 7%. After alphathesin (CT 1341) and propanidid, the arterial segments dilated about 20%, after etomidate and 4-hydroxybutyrate about 10%. The muscle relaxants suxamethonium and d-tubocurarine induced dilations of 10 to 15%, alcuronium and pancuronium, however, of less than 5%. The results presented here concur with those of experiments in vivo in which the influence of narcotics and relaxants on the peripheral resistance was studied. This indicates that the dilatation of peripheral resistance vessels seen after the administration of such agents is not exclusively caused by a neurally mediated inhibition of the vascular tone. The direct action of these substances on the vascular smooth muscle may often contribute to their complex haemodynamic effects.

Animals↗